View source for ACLS (Main)

''See [[critical care quick reference]] for drug doses and equipment size by weight.'' {{Adult top}} [[PALS (Main)]].''
==Background==
*A series of clinical algorithms created by the AHA/ASA used in the treatment of cardiovascular/neurological emergencies.
*Involves airway management, IV access, and ECG interpretation.

==[[ECG]] Analysis==
*What is the atrial and ventricular rate?
*Is the rhythm regular or irregular?
**If irregular, does it follow any repeatable pattern?
*What is the axis?
**ERAD often seen in VT but not SVT
*What is the P wave amplitude, duration, morphology, and synchrony with QRS complex?
**Is the P wave positive in Lead II
*What is the QRS complex amplitude, duration, morphology?
*What is the T wave amplitude, duration, morphology?
**Is the T wave positive in Lead II
*What is the length of PR and QT intervals?
*Is there ST Elevation/Depression or Hyperacute T waves?
**If yes, does it follow any anatomical pattern or is it diffuse?
*Is there anything else abnormal about this ECG?
**Pacemaker Spikes
**Hypertrophy of atrial/ventricles

==Algorithms==
*[[Adult Pulseless Arrest]]
**Pulseless Ventricular Tachycardia/Ventricular Fibrillation
**Pulseless Electrical Activity/Asystole
**Cardiac Arrest In Pregnancy
*Adult [[Post-Cardiac Arrest Care]]
*Termination of Resuscitation
*[[ACLS: Bradycardia]] (with pulse)
*[[ACLS: Tachycardia]] (with pulse)
*[[Acute coronary syndrome]]
*Suspected [[cerebrovascular event]]

==Treatable Conditions==
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Condition'''
| align="center" style="background:#f0f0f0;"|'''Common clinical settings'''
| align="center" style="background:#f0f0f0;"|'''Corrective actions'''
|-
| [[Acidosis]]||
*Preexisting [[acidosis]], [[DM]], [[diarrhea]], [[drugs and toxins]], prolonged resuscitation, renal disease, [[shock]]
||
*Reassess adequacy of [[oxygenation]], and [[ventilation]]; reconfirm [[endotracheal-tube placement]]
*Hyperventilate 
*Consider intravenous [[bicarbonate]] if pH <7.20 after above actions have been taken
|-
| [[Cardiac tamponade]]||
*Hemorrhagic diathesis, cancer, [[pericarditis]], [[trauma]], after cardiac surgery or [[MI]]
||
*Give [[fluids]]; obtain [[bedside echocardiogram]] 
*Perform [[pericardiocentesis]]. Immediate surgical intervention is appropriate if pericardiocentesis is unhelpful but cardiac tamponade is known or highly suspected. 
|-
| [[Hypothermia]]||
*[[Alcohol abuse]], [[burns]], CNS  disease, debilitated or elderly patient, [[drowning]], [[drugs and toxins]], endocrine disease, history of exposure, homelessness, extensive skin disease, spinal cord disease, [[trauma]]
||
*If severe (temperature <30°C), limit initial shocks for [[V-Fib]] or [[pulseless V-Tach]] to three; initiate active internal rewarming and cardiopulmonary support. Hold further resuscitation medications or shocks until core temperature is >30°C. 
*If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas
|-
| [[Hypovolemia]], [[hemorrhage]], [[anemia]]||
*Major [[burns]], [[DM]], GI losses, hemorrhage, hemorrhagic diathesis, cancer, [[pregnancy]], [[shock]], [[trauma]]
||
*Give [[fluids]] 
*Transfuse [[pRBCs]] if hemorrhage or profound anemia is present 
*[[Thoracotomy]] is appropriate when patient has [[cardiac arrest]] from [[penetrating trauma]] and a cardiac rhythm and the duration of cardiopulmonary resuscitation before thoracotomy is <10 min
|-
| [[Hypoxia]]||
*Consider in all patients with cardiac arrest
||
*Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
|-
| [[Hypomagnesemia]]||
*[[Alcohol abuse]], [[burns]], [[DKA]], severe [[diarrhea]], diuretics, drugs (eg, cisplatin, cyclosporine, pentamidine)
||
*Give 1-2 g [[magnesium sulfate]] intravenously over 2 min
|-
| [[Myocardial infarction]]||
*Consider in all patients with [[cardiac arrest]], especially those with a history of [[coronary artery disease]] or prearrest [[acute coronary syndrome]]
||
*Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass)
|-
| [[Poisoning]]||
*[[Alcohol abuse]], bizarre or puzzling behavioral or metabolic presentation, classic [[toxicologic syndrome]], occupational or industrial exposure, and psychiatric disease
||
*Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote
*Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available
|-
| [[Hyperkalemia]]||
*[[Metabolic acidosis]], excessive administration of potassium, [[drugs and toxins]], vigorous exercise, hemolysis, renal disease, [[rhabdomyolysis]], [[tumor lysis syndrome]], and clinically significant tissue injury
||
*If hyperkalemia is identified or strongly suspected, treat with all of the following: 10% [[calcium chloride]] (5-10 mL by slow intravenous push; do not use if hyperkalemia is secondary to [[digitalis poisoning]]), [[glucose]] and [[insulin]] (50 mL of 50% dextrose in water and 10 units of regular insulin intravenously), [[sodium bicarbonate]] (50 mmoL intravenously; most effective if concomitant [[metabolic acidosis]] is present), and [[albuterol]] (15-20mg nebulized or 0.5mg by intravenous infusion)
|-
| [[Hypokalemia]]||
*[[Alcohol abuse]], [[diabetes]], use of [[diuretics]], [[drugs and toxins]], profound gastrointestinal losses, [[hypomagnesemia]]
||
*If profound hypokalemia (<2-2.5 mmoL of potassium per liter) is accompanied by cardiac arrest, initiate urgent intravenous replacement (2 mmoL/min intravenously for 10-15 mmoL), then reassess
|-
| [[Pulmonary embolism]]||
*Hospitalized patient, recent surgical procedure, peripartum, known risk factors for [[venous thromboembolism]], history of venous thromboembolism, or prearrest presentation consistent with diagnosis of acute [[pulmonary embolism]]
||
*Administer [[fluids]]; augment with [[vasopressors]] as necessary 
*Confirm diagnosis, if possible; consider immediate cardiopulmonary bypass to maintain patient's viability 
*Consider definitive care (eg, thrombolytic therapy, embolectomy by interventional radiology or surgery) 
|-
| [[Tension pneumothorax]]||
*Placement of [[central catheter]], [[mechanical ventilation]], pulmonary disease (including [[asthma]], [[chronic obstructive pulmonary disease]], and necrotizing [[pneumonia]]), [[thoracentesis]], and [[trauma]]
||
*[[Needle decompression]], followed by [[chest-tube insertion]]
|}

==See Also==
*[[AHA ACLS Recommendation Changes by Year]]
*[[ACLS (Treatable Conditions)]]
*[[BLS (Main)]]
*[[Critical care quick reference]]
*[[Post cardiac arrest]]
*[[PALS (Main)]]

==External Links==
*[https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf 2020 AHA Guidelines]
*[http://www.blog.numose.com/emed-basics/pulseless Numose EMed: The Pulseless Patient]
*[http://www.blog.numose.com/emed-cardiology/bradycardia Numose EMed: ACLS Bradycardia]
*[http://www.blog.numose.com/emed-cardiology/svt Numose EMed: ACLS Narrow Complex Tachycardia]
*[http://www.blog.numose.com/emed-cardiology/wct Numose EMed: ACLS Wide Complex Tachycardia]

==References==
<references/>

[[Category:Cardiology]]
[[Category:EMS]]
[[Category:Critical Care]]