ACLS Cardiac Arrest Algorithm - Innovative Solutions

Copyright ©2010 American Heart Association ACLS Cardiac Arrest Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

ACLS Cardiac Arrest Circular Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

Bradycardia Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

Tachycardia Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767

Post-cardiac arrest care algorithm

Peberdy, M. A. et al. Circulation 2010;122:S768-S786

Acute Coronary Syndromes Algorithm

O'Connor, R. E. et al. Circulation 2010;122:S787-S817

Goals for management of patients with suspected stroke

Jauch, E. C. et al. Circulation 2010;122:S818-S828

ACLS Code Drugs

Drug Indications Dosage Administration

Adenosine/ Narrow PSVT/SVT 6 mg followed by 12mg in 1-2 Rapid IV push close to the
Adenocard Wide QRS Tachy of min. hub followed by a saline
Amiodarone uncertain cardiac origin bolus.
Vfib/pulseless VT, 300mg IVP for cardiac arrest. Draw up with filtered
Atropine VT with a pulse. May be Consider repeating with 150mg needle. Administer drip with
used for rate control of in 3-5 min. filtered tubing.
Calcium Chloride WPW or atrial tachycardias. 150mg over 10 min for stable
VT, may repeat 150mg every 10 Gtt infusion mixed
Dopamine min as needed. Cumulative dose 900mg/500 D5W.
Epinephrine of 2.2 IV in 24 hrs. 1mg/min = 33.3cc/hr
Slow infusion 360mg IV over 6 .5mg/min = 16.6cc/hr
hrs, maintenance 540mg over 18
hrs. (0.5mg/min) Half life is up to 40 days.

Symptomatic sinus .5 mg IV every 3-5 min for Do not give less than 0.5mg
bradycardia.
bradycardia, not to exceed 3 mg IV.

Tracheal 2-3mg diluted in 10cc May be given IV, IO, or ET
NS.
Does not work with heart
transplant patients due to
denervation.

Known or suspected 8-16mg/kg IV for hyperkalemia Do not mix with sodium
hyperkalemia (renal fx). and calcium channel blocker bicarbonate.
Hypocalcemia after multiple overdose.
blood tx. Antidote for
calcium channel blockers or
beta blocker overdose

Used for hypotension with Mixed 400mg/250D5W IV line must be a good one.
signs and symptoms of 2-10mcg/kg/min. Will cause extravasation
shock or bradycardia with infiltration

Cardiac arrest, VF, pulseless Cardiac arrest: 1mg of the Do not mix with sodium
VT, asystole, PEA 1:10,000 administered q 3-5 min bicarbonate.
follow each dose with IV flush. 1mg/250cc: 1mcg/min = 15
Symptomatic bradycardia, cc/hr.
severe hypotension, Bradycardia or hypotension use
anaphylaxis a gtt. May be given IV, IO or ET

Drug Indications Dosage Administration

Magnesium Sulfate Torsades de pointes or 1-2 gm diluted in 10 cc D5W May cause fall in BP with
suspected hypomagnesemia. IVP if in cardiac arrest. rapid administration.
Life threatening arrhythmias
due to dig toxicity. If not in cardiac arrest mix 1-2 Use with caution if renal
gm in; 50 to 100 cc D5W to failure is present.
infuse over 5 to 60 min.
Given slow IV over 1-2 min
Morphine Sulfate Used for treatment of Dosage should be in 1 to 2 mg
ischemic chest pain, acute increments up to 10 mg max Precautions: respiratory
cardiogenic pulmonary depression and hypotension
edema, anxiety
IV or IO meds should be
Decreases the myocardial given over 1 min.
preload and causes
peripheral venous pooling. Precautions: If given rapidly
IV/IO can cause projectile
Narcan/Naloxone Used to reverse respiratory Dosage – 0.4 mg to 2 mg IV or vomiting
depression that results from IO and may be given ET
narcotics Patient may become
agitated or violent
Also used for coma of
unknown etiology End Points: Arrhythmia
suppressed, hypotension
Procainamide Anti-arrhythmic for stable 20-50 mg/min ensues, QRS duration
wide QRS Tachycardia increase >50%, max dose
17 mg/kg
Sotalol Hemodynamically Stable 100 mg over 5 min or Avoid if prolonged QT
Sodium Bicarbonate Monomorphic Ventricular 1.5 mg/kg over 5 min
Tachycardia Not recommended for
3rd Line Anti-Arrhythmic 1 meq/kg IV bolus. routine use in cardiac arrest
Repeat half dose q 10 min patients.
Preexisting hyperkalemia,
metabolic acidosis, Do not give any epi for
prolonged resuscitation. 10 min after vosopressin is
given.
Vasopressin May be used as an IV, IO 40 U IV push X 1 dose
only.
alternative pressor to epi in ET 80U X 1 dose only

the treatment of Cardiac
Arrest instead of 1st or 2nd

dose of epi

Compiled by: innovative solutions
Rebecca Cass, NREMT-P
in healthcare education, llc

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