NO

1
ACLS Summary

• REMEMBER
• check pulses after each drug/maneuver/shock
• Safety of team always clear
• Sync Monitor for cardioversion
• Ensure CPR 100/min, Vents 10/min, check ETT

lt48 hrs of A. Fib/A. Flutter Rate
Control Diltiazem OR Metoprolol (VF
preserved) Diltiazem OR Digoxin
OR Amiodarone (VF impaired) DC Cardioversion
gt48 hrs of A. Fib/A. Flutter Rate Control
Diltiazem OR Metoprolol (VF preserved)
Diltiazem OR Digoxin OR Amiodarone (VF
impaired) Urgent Cardiovert within 24hrs IV
heparin prior anticoag 4 wks Delayed
Cardiovert anticoag 3 wks, cardiovert, anticoag
4 wks
Stable/Not Stable Vitals (low BP, low RR),
Chest Pain, SOB, LOC, worsening CHF, Pulmonary
Edema
Primary Survey ABCs Call for help / Call code O2,
IV, Monitors Not breathing? ? Bag Ventilations (2
breaths)
Pulse Present
No Pulse
Start CPR 152 before ETT
VF / pulseless VT
Asystole
PEA
Tachycardic
Bradycardic
Check leads, gain, machine (different
lead) Consider TCP if short down time
Intubate, IV
Non-syncd Defibrillation 200, 300, 360J
Unstable
Stable
Unstable
Stable
Epi 1mg q3-5min Atropine 1mg q3-5 if HR lt60
Consider Syndd Early Cardioversion
Check Pulse Intubate, IV
Intubate, IV
Type II, 2 degree 3 degree heart block
Narrow
A. Fib/ A. Flutter
Wide
Consider sedation 50 mcg Fentanyl Syncd
Cardioversion 100, 200, 300, 360J
NO
YES
12 lead ECG Vagal Maneuvers Adenosine 6mg IVP
20cc NS, repeat 12mg IVPx2
Epi 1mg q3-5min Atropine 1mg (max 0.04/kg)
12 lead ECG Old ECG
Search for Cause Hypovolemia Hypoxia H
acidosis Hyper/Hypokalemia Hypothermia Tablets Tam
ponade Tension Pneumo Thrombosis
Coronary Thrombosis Pulmonary
TVP TCP
Observe
Epi 1mg IV q3min OR Vasopressin 40 units IVP once
(Defibrillate 360J after each Epi/other
drug) Consider Amiodarone 300mg bolus then 150
mg bolus after 3-5min Lidocaine 1.5 mg/kg IV (max
3 mg/kg) Procainamide 50 mg/min IV (max 17
mg/kg) MgSulfate 2g bolus (if indicated) in 10cc
D5W
Amiodarone 150mg IV over 10min ? 1mg/kg(6h), 0.5
mg/min(18h) Diltiazem 0.25mg/kg slow IVP (2min).
Repeat 0.35mg/kg after 15-30min Verapamil 2.5-5mg
IVP Procainamide 20-30 mg/min Metoprolol 5mg IVP
q3-5min x3 Labetolol 10mg IVP over 1-2 min (max
150 mg) Digoxin 0.1-0.5mg IVP
Sync Cardioversion OR Procainamide 20-30mg
IVP OR Amiodarone 150mg IV(10min)
Atropine 0.5 - 1mg q5min TCP (start 70bpm 20
mA) Dopamine 5-20 mcg/kg/min Epi 2-10
mcg/min Isoprotenerol 2-10 mcg/min Prepare for TVP
Do not use if EFlt40