ACLS (Main)

(Redirected from Cardiac arrest)

See critical care quick reference for drug doses and equipment size by weight. This page is for adult patients. For pediatric patients, see: PALS (Main).


  • 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


Treatable Conditions

Condition Common clinical settings Corrective actions
  • 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.
  • 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
  • Consider in all patients with cardiac arrest
  • Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
  • 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)
  • 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
  • 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)
  • 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

External Links