Cardiac Arrest Algorithm
Note the key change in BLS sequence: begin early chest compressions.
BLS is no longer represented by A, B, C, and D; it is represented by 1, 2, 3, and 4.
Step 1: Assess responsiveness.
Step 2: Active emergency response and get AED.
Step 3. Check carotid pulse for 10 seconds. If no pulse, begin CPR, starting with chest
compressions then 2 breaths at a ratio of 30:2. Use bag valve mask for breaths, if available.
Step 4: Defibrillate if there is a shockable rhythm when defibrillator arrives. Continue CPR while the
defibrillator or AED is readied. Responders should follow the voice prompts.
Step 5: Proceed to ABCD of secondary survey.
1. Airway: Head tilt-chin-lift; use advanced airway if needed.
2. Breathing: Supplementary oxygen; maintain ventilation and oxygenation.
3. Circulation: Monitor CPR quality with waveform capnography.
o Attach monitor.
o Defibrillate/cardiovert.
o Obtain IV/IO access.
o Give appropriate drugs:
Pressors: Epinephrine 1 mg IV q 3 -5 minutes. May substitute Vasopressin 40
U IV for dose 1 or dose 2.
Antiarrhythmics: Amiodarone 300 mg IV. May repeat a second dose of 150
mg IV
4. Differential diagnosis: Look for reversible causes. 5 H's and 5 T's.
Ventricular Fibrillation and Pulseless Ventricular
Tachycardia
Step 1: Cardiac Arrest Algorithm: BLS and AED.
, Biphasic defibrillators - 120 to 200 J per manufacturer; 360 J monophasic defibrillator.
The 2010 Guidelines recommends interruption in chest compression only for ventilation
without an advanced airway, rhythm checks, and shock delivery.
The American Heart Association recommends shortening the interval between last
compression and shock.
The emphasis in ACLS is on high quality CPR. Monitor with qualitative waveform
capnography. If PETCO2 is less than 10 mm Hg, attempt to improve CPR quality.
Step 2: ACLS: Secondary survey.
Step 3: Vasopressin 40 U IV x 1 (Class 2b) or epinephrine 1 mg q 3-5 minutes (Class Indeterminate.
Step 4: Defibrillate: Biphasic – 120 or 200, use manufacturer's instructions.
Step 5: Antiarrhythmic: Amiodarone 300 mg IV/IO; may repeat x 1 at 150 mg (Class 2b)
-Consider lidocaine if amiodarone is not available 1.0-1.5 mg/kg IV/IO first dose, then 0.5-0.75 mg/kg
IV/IO diluted in 10 ml D5@, NS) as IV/IO bolus over 5-20 minutes
Step 6: Defibrillate
Step 7: Go back to Step 3.
PEA/Asystole
Step 1: Cardiac Arrest Algorithm: BLS and AED.
Interrupt chest compressions only for ventilation without an advanced airway, rhythm
checks, and shock delivery. High quality CPR is emphasized.
Step 2: ACLS: Secondary survey: confirm asytole, do not delay CPR for pulse check.
Step 3: Rule out reversible causes: 5H's and 5 T's.
Empiric fluid challenge
Wide QRS suggests significant cardiac damage: hyperkalemia, hypoxia, hypothermia
Wide QRS and slow rhythm: consider overdose , hypoxia
Narrow complex suggests intact heart: consider hypovolemia, infection, PE, tamponade
Note the key change in BLS sequence: begin early chest compressions.
BLS is no longer represented by A, B, C, and D; it is represented by 1, 2, 3, and 4.
Step 1: Assess responsiveness.
Step 2: Active emergency response and get AED.
Step 3. Check carotid pulse for 10 seconds. If no pulse, begin CPR, starting with chest
compressions then 2 breaths at a ratio of 30:2. Use bag valve mask for breaths, if available.
Step 4: Defibrillate if there is a shockable rhythm when defibrillator arrives. Continue CPR while the
defibrillator or AED is readied. Responders should follow the voice prompts.
Step 5: Proceed to ABCD of secondary survey.
1. Airway: Head tilt-chin-lift; use advanced airway if needed.
2. Breathing: Supplementary oxygen; maintain ventilation and oxygenation.
3. Circulation: Monitor CPR quality with waveform capnography.
o Attach monitor.
o Defibrillate/cardiovert.
o Obtain IV/IO access.
o Give appropriate drugs:
Pressors: Epinephrine 1 mg IV q 3 -5 minutes. May substitute Vasopressin 40
U IV for dose 1 or dose 2.
Antiarrhythmics: Amiodarone 300 mg IV. May repeat a second dose of 150
mg IV
4. Differential diagnosis: Look for reversible causes. 5 H's and 5 T's.
Ventricular Fibrillation and Pulseless Ventricular
Tachycardia
Step 1: Cardiac Arrest Algorithm: BLS and AED.
, Biphasic defibrillators - 120 to 200 J per manufacturer; 360 J monophasic defibrillator.
The 2010 Guidelines recommends interruption in chest compression only for ventilation
without an advanced airway, rhythm checks, and shock delivery.
The American Heart Association recommends shortening the interval between last
compression and shock.
The emphasis in ACLS is on high quality CPR. Monitor with qualitative waveform
capnography. If PETCO2 is less than 10 mm Hg, attempt to improve CPR quality.
Step 2: ACLS: Secondary survey.
Step 3: Vasopressin 40 U IV x 1 (Class 2b) or epinephrine 1 mg q 3-5 minutes (Class Indeterminate.
Step 4: Defibrillate: Biphasic – 120 or 200, use manufacturer's instructions.
Step 5: Antiarrhythmic: Amiodarone 300 mg IV/IO; may repeat x 1 at 150 mg (Class 2b)
-Consider lidocaine if amiodarone is not available 1.0-1.5 mg/kg IV/IO first dose, then 0.5-0.75 mg/kg
IV/IO diluted in 10 ml D5@, NS) as IV/IO bolus over 5-20 minutes
Step 6: Defibrillate
Step 7: Go back to Step 3.
PEA/Asystole
Step 1: Cardiac Arrest Algorithm: BLS and AED.
Interrupt chest compressions only for ventilation without an advanced airway, rhythm
checks, and shock delivery. High quality CPR is emphasized.
Step 2: ACLS: Secondary survey: confirm asytole, do not delay CPR for pulse check.
Step 3: Rule out reversible causes: 5H's and 5 T's.
Empiric fluid challenge
Wide QRS suggests significant cardiac damage: hyperkalemia, hypoxia, hypothermia
Wide QRS and slow rhythm: consider overdose , hypoxia
Narrow complex suggests intact heart: consider hypovolemia, infection, PE, tamponade
