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Agorithm
Cardiac Arrest Adult Cardiac
Algorithm Arrest
Shout for
Help/Activate
• For witnessed arrest: EMS
Call for Help
• For unwitnessed arrest:
Give 5 Cycles of CPR
before calling for help
Cardiac Arrest Adult Cardiac
Algorithm Arrest
Shout for
Help/Activate
• Check for a pulse EMS
Shout for
Help/Activate
• Check the patient's EMS
rhythm,
Start CPR
• Taking less than 10 FIRST cycle
seconds to assess.
• Simultaneuosly, check Check for
for Pulse Rhythm
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Pulseless Ventricular tachycardia
• Ventricular Fibrillation
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Unwitnessed arrest:
means CPR before
Give FIRST Shock
shock
• Witnessed arrest:
SHOCK FIRST!
Talk aloud:
Give FIRST Shock
• “Shocking now, 200
Joules“
• "Resume CPR please“
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Ventricular Fibrillation
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Unwitnessed arrest:
means CPR before Give SECOND
shock Shock
• Witnessed arrest:
SHOCK FIRST!
shock".
• Make sure you get
everyone clear first. "I am
clear, you are clear,
everybody clear"
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
Joules“
• "Resume CPR please“
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
for Pulse
Check for
Rhythm
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Pulseless Ventricular tachycardia
• Ventricular Fibrillation
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Unwitnessed arrest:
means CPR before Give THIRD
shock Shock
• Witnessed arrest:
SHOCK FIRST!
shock".
• Make sure you get
everyone clear first. "I am
clear, you are clear,
everybody clear"
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
Joules“
• "Resume CPR please“
Shockable
Cardiac Arrest
Algorithm
VF/Pulseless VT
• Give 5 cycles of CPR
• give Amiodarone
Give THIRD
300mg IV before the Shock
next shock, in the
middle of the fourth Start CPR
round of CPR FOURTH cycle
Start CPR
FOURTH cycle
Check for
Rhythm
Not
Cardiac Arrest Shockable
Algorithm
Asystole/PEA
• Asystole
for Pulse
Not
Cardiac Arrest Shockable
Algorithm
Asystole/PEA
5H’s
Hypovolemia Check for
Hypoxia Rhythm
Hydrogen Ion (acidosis)
Hypo/Hyperkalemia Start CPR
Hypothermia SECOND cycle
Not
Cardiac Arrest Shockable
Algorithm
Asystole/PEA
• Treat reversible Cause:
Start CPR
5T’s FIRST cycle
Tension pneumothorax
Tamponade, Cardiac Check for
Toxins Rhythm
Thrombosis, Pulmonary
Thrombosis, Coronary Start CPR
SECOND cycle
Bradycardia (with Pulse)
HR < 50/min
Algorithm
Attach:
• Oxygen by simple face
mask
• start an IV
• Pulse oximeter
• NIBP
• Draw venous blood
Bradycardia (with Pulse)
HR < 50/min
Algorithm
Stable:
• No chest pain Stable
• No SOB
• No hypotension
• No altered mental
status or any signs of
shock.
Bradycardia (with Pulse)
HR < 50/min
Algorithm
Unstable:
• Chest pain Unstable
• Shortness of breath
• Hypotension
• Altered mental status
• Shock
• Pulmonary Edema
Bradycardia (with Pulse)
HR < 50/min
Algorithm
• Atropine 0.5mg IV
• This may be repeated Unstable
every 3-5 min up to a
max of 3mg
Give Atropine
Bradycardia (with Pulse)
HR < 50/min
Algorithm
If atropine is ineffective:
• Turn on the Monitor Unstable
Defibrillator
• Select lead II
• Place the electrodes Give Atropine
• Make sure the pacer is
in Demand mode.
Trancutaneous
Pacing
Bradycardia (with Pulse)
HR < 50/min
Algorithm
• Set the rate at 70-80
• Set current strength at
Unstable
40-60 mA
• Watch the monitor for
electrical capture.
• Now check the pulse Give Atropine
Trancutaneous
Pacing
Bradycardia (with Pulse)
HR < 50/min
Algorithm
No capture:
• Switch the pacemaker Unstable
to non-demand mode,
where it fires at a set
interval regardless of Give Atropine
intrinsic rhythm.
Trancutaneous
Pacing
Bradycardia (with Pulse) Dopamine/
Algorithm Epinephrine
If TCP fails:
• Start Dopamine at 2-10
micrograms/kg/minute
OR
• chest pain
• shortness of breath Unstable
• hypotension
• altered mental status
• shock
• pulmonary edema
Tachycardia (with Pulse)
HR > 150/min
Algorithm
Attach the Defibrillator:
• Press the SYNC button
• Defibrillator should be Unstable
flagging the R waves
• Start with an energy
setting of 100 joules Synchronized
Cardioversion
• Press the shock button
• After each shock , do a
pulse check.
Tachycardia (with Pulse)
HR > 150/min
Algorithm
min, 15 mg
Narrow QRS
Irregular rhythm
Tachycardia (with Pulse)
HR > 150/min
Algorithm
• Administer Adenosine
First dose: Adenosine 6mg
rapid IV push; follow with Stable
NS flush
Second dose: 12 mg
Wide QRS
Regular Rhythm
Monomorphic
Tachycardia (with Pulse)
HR > 150/min
Algorithm
• Administer Amiodarone IV
dose
• First dose: 150 mg over 10
Stable
min, follow by maintenance
infusion of 1mg/min for first
6 hours
Wide QRS
Irregular Rhythm
Polymorphic
Tachycardia (with Pulse)
HR > 150/min
Algorithm
• Administer Magnesium 2gm
IV
Stable
Torsades de
Pointes