Download ACLS Asystole

ACLS Cardiac Arrest
1
If unwitnessed
Start HPCPR 2 min
- Give oxygen
- Attach monitor/defibrillator
Yes
If witnessed
begin compressions
- Attach monitor/defibrillator
No
Rhythm shockable?
2
9
VF/VT
3
4
Doses/Details
CPR Quality: (per current HPCPR guidelines)
- Push hard (> 2 inches [5 cm]) and fast
(110/min) allow complete chest recoil
- Minimize interruptions in compressions
- Avoid excessive ventilation
- Rotate compressor every 2 minutes
- Ratio: 10 compressions to 1 ventilation
simultaneously
- Quantitative waveform capnography
If PETCO2 <10 mm Hg, attempt to
improve CPR quality
Asystole/PEA
Shock
Return of Spontaneous Circulation (ROSC):
- Pulse and blood pressure
HPCPR 2 min
- IV/IO access
Rhythm shockable?
Shock Energy:
- Biphasic: Manufacturer recommendation
(120-200J) if unknown, use maximum
available
Second and subsequent doses should be
equivalent, and higher doses may be
considered
- Monophasic: 360 J
No
Yes
5
6
Shock
10
HPCPR 2 min
HPCPR 2 min
- Epinephine every 3-5 min
- Consider advanced
airway & capnography
- IV/IO access
- Epinephine every 3-5 min
- Consider advanced
airway & capnography
No
Yes
Rhythm shockable?
Rhythm shockable?
Yes
7
11
Shock
Advanced Airway:
- Supraglottic advance airway or ETT
- Waveform capnography to confirm and
monitor ET tube placement
- With ETT or Supraglottic Airway placed ratio
remains 10 compressions to 1 ventilation
simultaneously
No
HPCPR 2 min
8
- Treat reversible causes
HPCPR 2 min
- Amiodarone
- Treat reversible causes
No
Rhythm shockable?
Yes

Dr. Larry Smith
Approved: 12/12/14
12
- If no signs of return of spontaneous circulation
(ROSC), go to 10 or 11
- If ROSC, go to Post-Cardiac Arrest Care protocol
Reviewed: 12/10/14
Revised: 12/12/14
Drug Therapy:
- Epinephrine IV/IO dose:
1 mg every 3-5 min
- Amiodarone IV/IO dose:
First dose: 300 mg bolus
Second dose: 150 mg
Go to
5 or 7
Document:
· Detailed Assessment
· Treatment
· Response to Treatment
· SpO2, Cardiac Rhythm, Vital Signs
· Verify ETT Placement
· Communication with Medical Control
Reversible Causes:
- Hypovolemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hypo-/hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
ACLS
Cardiac Arrest