Adult Cardiac Arrest Management Algorithm

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Adult Cardiac Arrest Algorithm

ACLS Adult Cardiac Arrest Algorithm

Figure 29

CPR Quality

  • Push hard enough to reach 2 inches depth and fast enough for 100 beats per minute, allowing recoil between every press
  • Limit interruptions
  • Avoid over-ventilating
  • If no advanced airway is available,use a 30:2 compression to ventilation ratio
  • Perform quantitative waveform capnography (attempt to improve CPR quality if ETCO2 < 10 mmHg
  • Monitor intra-arterial pressure (attempt to improve CPR quality if diastolic pressure < 20 mmHg.

Shock Energy

  • Biphasic: Older monophasic waveforms are not nearly as effective as the delivery of biphasic energy during defibrillation. For the right doses, stick to manufacturer recommendations; if these are not available, use the maximum setting available.The next doses must be equivalent and potentially higher.
  • Monophasic: 360 J

Return of Spontaneous Circulation

  • Perform ET intubation or supraglottic advanced airway
  • Observe and confirm ET tube placement with waveform capnography
  • With continuous chest compressions, apply 8 to 10 breaths every minute

Advanced Airway

  • Supraglottic advanced airway or ET intubation
  • Waveform capnography to confirm and monitor ET tube placement
  • 8 to 10 breaths per minute with continuous chest compressions

Drug Therapy

  • Epinephrine IV/IO Dose: 1 mg every 3 to 5 minutes
  • Amiodarone IV/IO Dose: initial dose of 300 mg bolus and a second dose of 150 mg

Reversible Causes

  • Hypothermia
  • Hypo-/hyperkalemia
  • Tamponade,cardiac
  • Thrombosis, pulmonary, or coronary
  • Hypovolemia
  • Hypoxia
  • H+(acidosis)
  • Toxins
  • Tension pneumothorax
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