ACLS Pocket Guide Previous guidelines VF/pulseless VT Defibrillation x 3 (200J,200J-300J,360J) , then Secondar !"#D (!ir$a, %& access) Vasopressin '0 Vasopressin '0 iv x onl (*referred first agent, #lass 2b) or epinephrine1mg+3-in epinephrine1mg+3-in (#lass %ndeterinant) %ndeterinant) Defibrillate at 360J or bi*hasic shoc. Amiodarone 300 g iv *ush (diluted in 20 cc D/) 1a r*t 0g x (#lass 2b) 1a re*eat 0 g x in 3- inutes Lidocaine 0-g.g iv* +3- in u* to 3 g.g (#lass %nderterinate) %nderterinate) #ontinuous infusion to ' gin !dd gra20 l 4ate (lhr)5 gin x ndotracheal tube 7ive 2 to 2 x %& dose Dilute u* to 0l $ith noral saline Magnesium -2 g iv if *olor*hic &8 or h*oagnesiuic (#lass 2b) Procainamid 30 gin u* to 9g.g :acce*table :acce*table but not recoended: e in refractor &; (class 2b) 0 lhr #ontinuous #ontinuou s infusion 2 to 6 gin !dd gra20 l D/ 4ate (lhr)5 gin x bicarbonate *rolonged arrest (#lass 2b), high ? Defibrillate 360J or bi*hasic shoc., re*eat drug fro above
Pulseless lectrical Acti!it"/MT Acti!it"/MT "asic #P4!"#D Secondar !"#D 4ule out ost coon etiolog @ *ovoleia, *ovoleia, @*oxia, @*erh*o.aleia, @*otheria A #onsider bicarbonate bicarbonate pinephrine g +3- in iv *ine*hrine strengthens ocardial contraction contraction and increases cardiac out*ut, $hich $ill hel* i*rove ocardial and cerebral blood flo$ Continuous in#usion$ in#usion$ to ' cgin (range -0 cgin) !dd g20 l D/ or BS Dri* rate (lhr)5 cgin x ndotracheal tube tube 7ive 2 to 2 x %& dose (Dilute u* to 0 l $ith noral saline) Atropine %f @4 slo$, g iv +3- in u* to 00'g.g
As"stole "!sic #P4!"#D confir asstole chec. onitor,lead,*o$er and change leads #onsider bicarbonate *rolonged arrest (#lass 2b), high ? 8ranscutaneous *acing, if used ust be considered earl, routine use not necessar pinephrine g iv +3-in Atropine g g iv +3- in u* to 00'g.g ndotracheal tube 7ive 2 to 2 x %& dose (Dilute u* to 0l $ith noral saline) !dverse reactions #BS toxicit treor, deliriu @*oh*ertension
%rad"cardia "!sic #P4!"#D Secondar !"#D !"#D assess need for air$a air$a etc Serious signs or s*tos of bradcardiaC if es, then do the se+uence Atropine g iv +3- in u* to 00'g.g 00'g.g 8hen transcutaneous transcutaneous *acing, then Do*aine &opamine -20 cg.gin pinephrine 2-0 cgin (!dd g20 l ) %s 8*e 2 second degree !& bloc. or third degree !& bloc. *resentC %f es standb transcutaneous *acea.er, *re*are for transvenous *acea.er
PSVT F normal normal Priorit #a-bloc.er beta-bloc.er digoxin D# #ardioversion #onsider *rocainaide, sotalol, aiodarone %f unstable *roceed to cardioversion
F'()*+ C,F Priorit Bo #ardioversion Digoxin or aiodarone or diltiaEe %f unstable *roceed to cardioversion
Atrial #ibrillation/#lutter$ Categor" 1- .ormal F ate control Verapamil 2 to g %& over 2 inutes 1a re*eat dose of -0g -30 inutes after st dose &iltia0em 02 g.g over 2 inutes %f no res*onse $ithin inutes, give second bolus of 03 g.g over 2 inutes Subse+uent doses should be individualiEed %f effective start continuous infusion - ghr smolol 00 cg.g %& over inute, follo$ed b 0 cg.ginute over ' inutes %f ineffective, re*eat load of 00 cg.g, follo$ed b 00 cg.gin Cardio!ert %f onset F 'G hours, consider D# cardioversion H4 $ith one of the follo$ing agents !iodarone, ibutilide, *rocainaide, (flecainide,*ro*afenone),sotalol %f onset 'G hours avoid drugs that a cardiovert (eg aiodarone) ither Delaed cardioversion anticoagulate ade+uatel x 3$ee.s then #ardiovert then anticoagulate x ' $ee.s butilide g %& over 0in 1a re*eat x in 0 inutes if needed !**roved for acute terination g0 l D/ or BS over 0 inutes %f *atient is F 60.g give 00 g.g over 0 inutes Amiodarone (non-cardiac arrest) load gin over 0 in (0 g) (ix 0 g in 00cc D/ in P&# or 7lass, infuse over 0 in) then gin x 6 hrs (ix >00 g in 00 cc D/) then 0 gin x G hrs and beond Anticoagulate if not contraindicated, if ! fib 'G hrs Categor" 2- F'()* or C,F (!void vera*ail, beta-bloc.ers, ibutilide, *rocainaide (and *ro*afenoneflecainide) ! 4ate control digoxin, diltiaEe, aiodarone (avoid if onset of !; 'G hours) " #ardiovert sae as #ategor , exce*t the onl conversion agent allo$ed is aiodarone # !nticoagulate, if ! fib '> hr Catepor" 3- 4P4 A #ib 1ust not use adenosine, beta-bloc.er, #a-bloc.er, Digoxin %f F 'G hour # F normal$ one of the follo$ing for both rate control and cardioversion aiodarone, *rocainaide, *ro*afenone, sotalol, flecainide # F abnormal or C,F aiodarone or cardioversion %f 'G hour 1edication listed above a be associated $ith ris. of eboli !nticoagulate and D# cardioversion as in #ategor
4ide comple5 tach"cardia+ STA%L %f unable to a.e Dx Bote no lidocaine and bretliu in *rotocol F normal D# cardioversion or *rocainaide or aiodarone F'()*+C,F D# #ardioversion or aiodarone Procainaide dosing
ntra!enous Medications Amiodarone$ -V- &6S C6MM.&AT6.S 77 FST 2( ,68S 77 Loading in#usions- 8he recoended starting dose of #ordarone %& is about 000 g over the first 2' hours of thera*, delivered b the follo$ing infusion regien First apid$ 19) mg o!er the FST - 1) minutes :19 mg/min;- !dd 3 < of #ordarone %& (0 g) to 00 < D / %nfuse 00 < over 0 inutes FolloT = hours :1 mg/min;- !dd G < of #ordarone %& (>00 g) to 00 < D / (conc 5 G g<) Maint in#usion 9() mg o!er the MA..G 1? hours :)-9 mg/min;!fter first 2' hours, the aint infusion rate of 0 gin (920 g2' hours) should be continued utiliEing a concentration of to 6 g< (#ordarone %& concentrations greater than 2 g< should be adinistered via a central venous catheter) %n the event of brea.through e*isodes of &; or heodnaicall unstable &8, 7ive 0-g00 l D/ over 0in to iniiEe *otential for h*otension 8he rate of the aint inf a be inc to achieve effective arrhthia su**ression 8 he initial infusion rate should not exceed 30 gin 8he aintenance infusion of u* to 0 gin can be cautiousl continued for 2 to 3 $ee.s regardless of the *atientIs age, renal function, or <& fcn liited ex*erience in *ts receiving #ordarone %& 3 $ee.s Amrinone (%nocor) 09 g.g bolus %& over 2-3in, fb infusion %& at -0 cg.gin Cisatracium %nterittent %& dosing initial dose 0 - 02 g.g %& bolus, follo$ed b 003 g.g %& +'0-60 inutes #ontinuous infusion 0-02 g.g bolus, follo$ed b to 3 cg.gin (range 0 to 0 cg.gin) "ased on a standard dilution of gl (eg 00g00l or 200g200l) and a $eight of 90.g cg.gin 5'2 lhr 3 cg.gin 526 lhr 0 g.g 50 g 02 g.g5' g &igo5in
