ACLS Cheat Sheet

ACLS Cheat Sheet Basic BLS You see a man collapse at a grocery store. What is the first thing you do?

Shake and shout. Establish unresponsiveness.

Next you...

activate the EMS and gets the AED

Unless there is a second rescuer, then ...

send them to activate the EMS and get AED

The plan for BLS is....

A, B, C, D

What do the letters represent?

A = Airway B = Breathing C = Circulation D = AED

With the patient, who is now unresponsive, you would...

open the airway and check for breathing.

How do you do this? Explain difference in trauma no trauma.

If there is no trauma or suspected trauma, use the heal tilt/chin lift method. If trauma or suspected trauma, use the jaw thrust method

After opening the airway you would...

check for breathing.

The method for this is...

look, listen, and feel for 5 to 10 seconds.

If there is no breathing, you will...

give 2 breaths. One second for each breath making sure there is visible chest rise.

After dealing with the breathing, you...

check carotid pulse.

If there is a pulse, then...

perform rescue breathing at 1 breath every 56 seconds (10-12 breaths a minute).

If you have a OPA or NPA, you...

insert the oropharyngeal or nasopharyngeal.

After airway insertion you...

use bag-mask ventilation with O2 if available

What else do you do with rescue breathing?

Check pulse every 2 minutes.

If you patient above has NO pulse, you...

start CPR.

What is the first thing in CPR?

Proper hand position.

What is the rate?

30:2. 30 compressions to 2 breaths.

How fast is the rate?

30 compressions in about 23 seconds/at a rate of 100 a minute.

How many cycles of CPR?

5 cycles.

The AED arrives; you...

attach AED and follow directions.

The pads...

must be placed correctly and be the proper size (adult size for ACLS).

When the AED advises a shock, you...

must make sure everyone is clear. “I’m clear, you’re clear, we’re all clear.” Then push the shock button.

After delivering the shock...

you IMMEDIATELY start CPR.

When giving CPR, what is very important?

Proper depth and full chest recoil.

If you have a defibrillator you attach it, and...

analyze the rhythm.

What are you analyzing for?

A shockable or unshockable rhythm.

A shockable rhythm would be...

VT/VF

An unshockable rhythm would be

asystole/PEA

If it is a shockable rhythm, you...

give 1 shock.

If your device is biphasic give...if monophasic give...

biphasic = 200J monophasic = 360J

After the shock is delivered you...

IMMEDIATELY start CPR

If you have a shock device immediately avail- Always shock first. able, do you give CPR first or shock first? It is important to now (if not already done by an IV/IO access. a team member) to start... The first drug to give is...

epinephrine

The dose and frequency is...

1 mg every 3 to 5 minutes.

Instead of epinephrine you can give...

vasopressin.

The dose and frequency is...

40 units 1 time only.

After 5 cycles of CPR you...

check rhythm.

If you need to shock again, you must...

continue chest compressions while device is charging.

After shock, you...

start CPR immediately.

What drug is next?

Amiodarone or lidocaine

Dose and method of administration of amiodarone is...

in VT/VF 300 mg IV/IO once, may consider a second dose of 150 mg.

Dose and method of administration of lidocaine is...

1 to 1.5 mg/kg IV/IO once, may repeat 0.5 to 0.75 mg/kg second dose.

Magnesium would be given if...

torsades or suspected alcohol abuse.

During CPR it is important to P___

push hard and fast (100/min)

Ensure full...

chest recoil.

Minimize...

interruptions in chest compressions.

One cycle of CPR is...

30:2 unless there is an advanced airway as LMA or pt is intubated.

How many cycles in 2 minutes?

5 cycles of CPR = 2 minutes.

If advanced airway is in place, how do you do Use continuous chest compressions and rate chest compressions and breathing? of breathing is 8-10 minute. Avoid hyperventilation. What is the mnemonic for treatable causes?

HHHHHHTTTTT. 6 H and 5 T.

What do they represent?

H = Hypovolemia H = Hypoxia H = Hydrogen ion (acidosis) H = Hypo/hyperkalemia H = Hypoglycemia H = Hypothermia T = Toxins T = Tamponade (cardiac) T = Tension pneumothorax T = Thrombosis (coronary or pulmonary) T = Trauma

A not shockable rhythm would be...

asystole/PEA

What do you do?

Resume CPR immediately.

Drugs?

Epinephrine 1 mg IV/IO every 3-5 minutes or one dose of vasopressin 40 units IV/IO

Also may consider what drug?

Atropine at 1 mg IV/IO. MAY REPEAT every 35 minutes for max of 3 doses.

How many cycles of CPR?

5

Then?

Reanalyze rhythm.

Bradycardia The criteria for treating bradycardia is...

a heart rate 150/minute

First thing to do is...

A, B, C as needed

Give...

O2

Start m...

monitoring

Ident... and treat

Identify and treat reversible causes

If symptoms persist, assess if...

stable or unstable.

To be unstable means...

altered mental status, ongoing chest pain, hypotension or other signs of shock.

If stable, check these 3 things...

Establish IV/IO access Obtain 12-lead EKG Check QRS to see if narrow (0.12 seconds), then...

Analyze if regular

If regular, then...

if VT or uncertain give amiodarone 150 mg IV/IO over 10 minutes. Repeat as necessary to max dose of 2.2 grams in 24 hours. Prepare for synchronized cardioversion.

If irregular, then...

3 possibilities: Atrial fibrillation with aberrancy Pre-excited atrial fibrillation (AF + WPW) Torsades de pointes

If AF, then...

treat per narrow complex tachycardia.

If Pre-excited atrial fibrillation (AF + WPW)

Expert consultation ADVISED AVOID AV nodal blocking agents as adenosine, digoxin, diltiazem, verapamil) Consider amiodarone 150 mg IV/IO over 10 minutes

If Torsades de pointes?

Give Magnesium at 1-2 Grams over 5 to 60 minutes.

Megacode checklist Bradycardia VF/Pulseless VT Asystole Bradycardia First that high-quality...

CPR at ALL times

Assign...

team roles

Starts...

O2, places monitor, starts IV (or delegates)

Recognizes

symptomatic bradycardia.

Administers...

appropriate drug(s) and doses.

Verbalizes...

the need for TCP

VF/Pulseless VT Management Recognizes...

VF

Clears...

before ANALYZE and SHOCK

Immediate...

resumes CPR after shock.

Appropriate...

airway management.

Appropriate cycles...

Drug/Rhythm Check/Shock/CPR

Administers...

appropriate drug(s) and doses

Asystole Management Recognizes...

asystole

Verbalizes...

potential reversible causes of Asystole/PEA (H’s and T’s)

Administers...

appropriate drug(s) and doses.

Immediately...

resumes CPR after rhythm checks.

Megacode Testing Checklist Tachycardia VF/Pulseless VT PEA Ensures...

high-quality CPR at all times

Assigns...

team members roles

Tachycardia Management Starts...

O2, places monitor, starts IV

Places...

monitor leads in proper position

Recognizes...

unstable tachycardia.

Recognizes...

symptoms due to tachycardia.

Performs...

immediate synchronized cardioversion.

VF/Pulseless VT Management Recognizes...

VF

Clears...

before ANALYZE and SHOCK

Immediately...

resumes CPR after shocks.

Appropriate...

airway management.

Appropriate cycles...

Drug/Rhythm Check/Shock/CPR

Administers...

appropriate drug(s) and doses

PEA Management Recognizes...

PEA

Verbalizes...

potential reversible causes of PEA/asystole (H’s and T’s)

Administers...

appropriate drug(s) and doses

Immediately...

resumes CPR after rhythm and pulse checks.

Megacode Testing Checklist Tachycardia VF/Pulseless VT PEA Ensures...

high quality CPR at all times.

Assigns...

team member roles.

Tachycardia Management Starts....

oxygen, places monitor, starts IV/IO

Places...

monitor leads in proper position

Recognizes...

tachycardia (specific diagnosis)

Recognizes...

no symptoms due to tachycardia.

Attempts...

vagal maneuvers.

Gives...

appropriate initial drug therapy.

VF/Pulseless VT Management Recognizes...

VF

Clears...

before ANALYZE and SHOCK

Immediately...

resumes CPR after shocks.

Appropriate...

airway management.

Appropriate...

cycles Drug/Rhythm Check/Shock/CPR

Administers...

appropriate drug(s) and doses

PEA Management Recognizes...

PEA

Verbalizes...

potential reversible causes of PEA/asystole (H’s and T’s).

Administers...

appropriate drug(s) and doses.

Immediately...

resumes CPR after rhythm and pulse checks.