ACLS Algorithms . Cardiac Arrest Algorithm . Cardiac Arrest Circular Algorithm . Immediate Post-Cardiac Arrest Care Algorithm . Tachycardia With a Pulse Algorithm . Bradycardia With a Pulse Algorithm . Acute Coronary Snydromes Algorithm . Suspected Stroke AlgorithmCardiac Arrest Algorithm Mitta ke aed Shout for Help/Activate Emergency Response PA uaty Pun hard 2 none fom Sel tat (2100 an aa complete chest eco! + Sinrzebterucion a compressions voi excemive veto + Boat compressor vey + Tio advanced away, 902 compresson-vortiston rio + Giartatve navetorm SAP 10m Hg atest toimpreve CPR gly + inievatralpeseure Mrelexaton prec ato) paar cen, tent {improve CPR ely Return of Spontaneous Coulton [A0SC) asa eo press 1 At sustained rece in reo, ype 240 mn Ha) + Sportnsous ater pesra worse th ao rmoneorng Shock Energy 1 Biphaste Manutactee ‘eoommendaton ort! {oxo oF 120-200 ferrous, ‘se mama aval. Seoond and sensor doone Stow be calor and higher oom ra be connec + Monopole 380.) ru Therapy 2 EBiophein WO Dose: Sing every 98 mewtes \enopressin WO Dose: 4D unt can replace fest or Score ose pining + Amiodarone V0 Dose: Fret oes" 900 mo bows. Second cons 15579. = Hypovolemia + 0 sans of retum of Spontaneous ereulaton {ROSC), goto 10 or 14 Tension preumothorax ‘Tamponado, cardiac Torre = ro a sein cot soverevanenoies a OZ Ammen cain Pte nt ta BSCardiac Arrest American Heart Circular Algorithm Association, Rk Etna ‘Shout for Help/Activate Emergency Response Return of Spontaneous 2 minutes Circulation (ROSC) IN/IO access Epinephrine every 3-5 minutes ‘Amiodarone for refractory VF/VT ‘Consider Advanced Airway Quantitative waveform capnography (PR Oust Shock Enea ery “pushed 2 inches fom) and est enare Nandacurr Cor eee ed itd ardatow covokieches "had andocure |” tate main « Maize rteruptons in compressions 120-200 J furknown, use * Gorm bbe pees fire eee vaie + Spent pr matey i Seton and aibseruer doses shuld Rlaticorpescrewy2mnice Seaman aessnen dreads Crm cen comers oat Sree oa vari oer not ‘be considered. Reversible Causes: « eunceaict cts, + Moembede3604 eae = ifPErco, <10 mmHg, attemptto Drug Therapy fa oe ws Inve GPm cult PeBinpte vn0 Dose: = Hoge on aids) + beeeeiee ting every 2-9 mines = We per ~ Hfrelaxation phase (diastolic) + Vasopressin IV/IO Dose: pressure <20 mm Hg, aftempt to = Tension proumothorax. = Tamponade, cardiac replace first or second Improve CPR quality dose of epinephrine Ba aes Return of Spontaneous Circulation + Amiodarone IV/IO Dose: = Thrombosis, pulmonary (Rosc) First dose: 300 mg bolus = Thrombosis, coronary * Pulse and blood pressure ‘Second dose: 150 mg + Abrupt sustained increase in Pero, (typically 240 mm Ha) ‘+ Spontancous arterial pressure waves wath intra-arterial monitoring (©2011 Amanican Haart AezocationImmediate Post-Cardiac Arrest Care Algorithm ery Saas ¥ No Follow ‘commands? Yes ‘STEM! oR high suspicion of AMI No ¥ American Heart Associations Doses/Detalls Ventilation/Oxygenation Avoid excessive ventiation. ‘Start at 10-12 breaths/min and titrate to target PETCO, (of 35-40 mm Hg, ‘When feasible, titrate Flo, to minimum necessary to achieve Spo, 294%, IV Bolus 4-2 Lnormal saline or lactated Ringer's. inducing hypothermia, may use 4°C fluid Epinephrine IV infusion: (0.1-0.5 meg/kg per minute (ia 70-kg adult: 7-85 meg per minute) Dopamine IV Infusion: 5-10 meg/kg per minute Norepinephrine IV Infusion: (0.1.0.5 meg/kg per minute (in 70-kg adult: 7-85 meg per minute) Reversible Causes = Hypovolemia = Hypoxia = Hydrogen ion (acidosis) = Hypo- hyperkalemia = Hypothermia Tension pneumothorax = Tamponade, cardiac = Toxins = Thrombosis, pulmonary = Thrombosis, coronary Se eo es ee aya j American Tachycardia Heart With a Pulse Algorithm Association. ck ee ‘Assess appropriateness for clinical condition. Heart rate typically 2150/min i tachyarrhythmi Doses/Detalls ‘Synchronized Cardioversion Initial recommended doses: * Nartow regular 50-100 J + Narrow iregular: 120-200 J biphasic oF 200 J monophasic * Wide regular: 100 J * Wide irregular: dofitiation Persistent tachyarrhythmia ‘dose (NOT synchronized) ere ‘Adenosine IV Dose: Hypotension? First dose: 6 mg rapid IV push; ‘Acutely altered mental status? follow with NS fush, ‘Signs of shock? Second dose: 12 mpi requ Isenere ost clscomtor? peimaeaa ts SULT Pout her fluro? Antiarrhythmic Infusions for ‘Stable Wide-QRS Tachycardia Procainamide IV Dose: 20-50 mg/min until arrhythmia ‘suppressed, hypotension {ensues, QRS duration incroases >50%, or maximum dose 17 mg/ka given. Maintenance infusion: 1-4 mg/min, Avoid prolonged QT or CHF. ‘Amiodarone IV Dose: First dose: 150 mg over 10 minutes. Repeat as needed VT recurs. Folow by ‘maintenance infusion of 11 ma/min for first 6 nours. Sotalol IV Dos 100 mg (1.5 mg/kg) over 5 minutes. Avoid it prolonged GT. Wide ans? 20:42 second (©2011 American Hoot Assocation. a : Bradycardia American _ With a Pulse Algorithm yy a Meike ke ead ‘Assess appropriateness for clinical condition. Heart rate typically <50/min if bradyanttythmi. Persistent bradyarrhythmia ‘causing: ++ Hypotension? * Acutely altered mental status? + Signs of shock? * Ischemic chest discomfort’? * Acute hear fallure? Yes Doses/Details ‘Atropine IV Dose: First dose: 0.5 mg bolis Repeat every 3-5 minutes Maximum: 3 ma Dopamine IV Infusion: 2-10 megrkg per minute Epinephrine IV Infusion: 2510 mog per minute aa cones ec ayAcute Coronary American Syndromes Algorithm Association. Riietcier kone "EMS assessment and care and hospital preparation ‘ Monitor, support ABCs. Be prepared to provide CPF and deflation ‘Administer aspirin and consider oxygen, nitroglycerin, and morphine F needed * Obtain 12-ead ECG: if ST elevation: = Natty reeelving hospital with transmission or interpretation; note ime of ‘onset and fst medical contact + Notifed hospital should mobilze hospital resources to respond to STEMI +f considering prehospital frnolysis, use irinolytic checkst ‘Concurrent ED assessment (<10 minutes) * Check vital signs: evaluate oxygen saturation * Estaalen IV access + Perio bie, targeted history, physical exam + Raviow/compiste fibrinolytic checklist; chack contraincieatons + Obtain intial cariac marker levels, inl electrolyte and eaaguation studies + Obtain portable chest x-ray (<30 mir) \immediate ED general treatment #110, sat <2496, stat oxygen at 4 Lin, irate * Aspirin 160 to 325 mg (f not given by EMS) + Nitroglycerin subingual or spray * Morphine IVI aiscomtort not rleved by nitroglycerin ‘ST elovation or now or presumably new LBBB; strongly suspicious for injury ‘ST-elevation Mi (STEMI ‘ST depression or dynamic ‘Twave inversion; strongly ‘suspicious for Ischemia High-risk unstable angina/ non-ST-elevation MI (UANSTEMI) Normal or nondiagnostic changes in ST sogment or T wave Low-/intermediate-risk ACS ‘Consider admission to ED ‘ohest pain unit or to ‘appropriate bed and follow: "Serial cardiae markers {including troponin) + Repeat ECG/continuous ST-segment monitoring * Consider nocivasive agnostic tes * Start adjunctive therapies as nciated + Donot delay reperfusion [ Troponin elevated or high-risk patient Consider earty invasive strategy + Refractory ischemic chest iscomfort . + Recurrentpersstent ST ceviation 2 | & Ventricular tachycardia + Hemosynamie instabilty + Signs of hear failure Time from onset of ‘symptoms $12 hours? Start adjunctive treatments as indicated * Ntrogtyeenn * Heparin (UFH or LMWH) * Consider: PO blockers * Consider: Clopidogrel * Consider: Glycoprotein lvl nhitor ‘Develops 1 oF more: * Clinical high-risk features “+ Dynamic ECG changes Consistent with ischemia «+ Troponin elevated ‘Abnormal diagnostic. noninvasive imaging or ‘Physiologic testing? ‘Admit to monitored bed ‘Assess rick status Continue ASA, heparin, and other ‘therapies os indicated ACE nhbtor/ARB + HIG Coa reductase inibtor (statin therapy) Not at high risk: cardiology to risk stratty Reperfusion goals: “Therapy defined by patient and + Door-to-balloon inflation (PCH) al of 90 minutes + Door-to-needle (fibrinolysis) {900 of 30 minutes no evidence of ischemia ‘or infarction by testing, an discharge with follow-upa American Suspected Stroke Algorithm fae i ee iit kon ‘Identity signs and symptoms Activate Emergency Ninos TIME Goals, £0 Acrival Immediate general assessment and stabilization 2, * Assess ABCs, vital signs: * Provide oxygen if hypoxemic * Obtain IV access and perform laboratory assessments * Check glucose; treat if indicated * Perform neurologic screening assessment * Activate stroke team * Order emergent CT scan or MAI of brain £0 + Obtain 12-lead EC ‘rival Immediate neurologic assessment by stroke team or designee ‘+ Review patient history Establish time of symptom onset or last known normal 25 '* Perform neurologic examination (NIH Stroke Scale or min Canadian Neurological Scale) ‘rival 8 ‘Does CT scan show hemorrhage? Consult neurolog! Probable acute ischemic stroke; consider fibrinolytic therapy (or neurosurgeon; + Check for fibrinolytic exclusions *= Repeat neurologic exam: are deficits rapidly improving to normal? cone eae, rot available Patient remains candidate for 0 fibrinolytic therapy? Arrival eOmin + Begin stroke or hemorrhage pathway ‘= Admit to stroke unit or Intensive care unit ‘Stroke [Admission ‘hours * Begin post-nPA stroke pathway * Aggressively monitor: = BP per protoco} = For neurologic deterioration + Emergent admission to stroke unit or intensive care unit 192011 American Hast Aasocaton