BLS ACLS 2010 algorithms

nivacicu's version from 2016-04-26 11:41


Not breathingGive 2 breaths
Pulse present1 breath q5-6 seconds, recheck pulse q2 minutes1 breath q3 seconds
No pulse30 compressions / 2 breaths, wait for AED30:2 if alone, 15 compressions / 2 breaths with partner, AED if > 1 y/o
shockable rhythm1 shock, resume CPR for 5 cycles
non-shockable rhythmresume CPR for 5 cycles, check rhythm q5 cycles

Bradycardia Algorithm

Bradycardia (<60 bpm)maintain airway, give O2, ECG, BP, O2 sat, IV access
Adequate perfusionobserve
Poor perfusiontranscutaneous pacing (consider atropine 0.5 mg IV, epi 2-10 ug/min, dop 2-10 ug/kg/min while waiting)Epi 0.01 mg/kg IV/IO or 0.1 mg/kg ET tube, q3-5 min, consider atropine 0.02 mg/kg (max 1g), consider pacing

Pulseless Arrest Algorithm

Shockable rhythmsVF / VT
Non-shockable rhythmsasystole / PEA
VF / VTgive one shock, resume CPR immediately2 J/kg then 4 J/kg after 5 cycles CPR, AED if > 1 y/o, use pediatric system if available 1-8 y/o
IV / IO availableEpi 1 mg IV / IO q3-5 min or 1 dose vasopressin 40 units to replace 1st or second doseEpi 0.01 mg/kg IV/IO or 0.1 mg/kg ET tube, q3-5 min
Asystole / slow PEAconsider atropine 1 mg IV / IO q3-5 min (up to 3 doses)
Asystole / PEAIV pressors +/- atropine, 5 cycles CPR, check rhythm
Antiarrhythmicsamiodarone (300 mg IV / IO once +/- 150 mg IV / IO once), lidocaine (1-1.5 mg / kg first dose, then 0.5 to 0.75 mg/kg IV / IO, up to 3 doses), Mg (1-2 g IV / IO loading dose for torsade de pointes)amiodarone 5 mg/kg, lidocaine 1 mg/kg, Mg 25-50 mg/kg (for torsades)
Possible contributing factorshypovolemia, hypoxia, hydrogen ion (acidosis) hypo / hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade (cardiac), tension pneumothorax, thrombosis (coronary / pulomonary), trauma

Tachycardia Algorithm

unstable patientsynchronized cardioversion (give sedation if possible)
stable patientIV access, ECG
regular narrow QRS (SVT)vagal maneuvers, adenosine 6 mg rapid IV push, followed by 12 mg IV push , may repeat onceinfants >220, kids >180, adenosine 0.1 mg/kg, synchronized cardioversion 0.5-1 J/kg, may increase to 2 J/kg the second time
irregular narrow QRS (a-fib, a-flutter, multifocal)control rate with diltiazem or BB (caution if pulmonary disease or CHF)
regular wide QRS (v-tach or uncertain rhythm)amiodarone 150 mg IV over 10 min, repeat as needed (max 2.2 g/24 hours), prepare for synchronized cardioversion0.5 - 1 J/kg then 2 J/kg, may try adenosine, maintain with amiodarone 5 mg/kg over 20-60 min or procainamide 15 mg/kg over 30-60 min while seeking consult
irregular wide QRSIf WPW avoid adenosine, digoxin, diltiazem, verapamil. Consider amiodarone 150 mg IV over 10 min. If torsades de pointes give Mg (load 1-2 f over 5-60 min, then infusion)