Adult Cardiac Arrest - ACLS Circular Algorithm - AHA ...
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Adult Cardiac Arrest - ACLS Circular Algorithm - AHA 2020

CPR Quality:

 • Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow complete chest recoil.

 • Minimize interruptions in compressions.

 • Avoid excessive ventilation.

 • Change compressor every 2 minutes. or sooner if fatigued.

 • If no advanced airway. 30:2 compression-ventilation ratio.

 • Quantitative waveform capnography - If PETCO2 is low or decreasing, reassess CPR quality.

Shock Energy for Defibrillation:

 • Biphasic: Manufacturer recommendation (eg. initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent. and higher doses may be considered.

 • Monophasic: 360 J

Drug Therapy:

 • Epinephrine IV/IO dose: 1 mg every 3-5 minutes

 • Amiodarone IV/IO dose: First dose: 300 mg bolus, Second dose: 150 mg OR

 • Lidocaine IVIIO dose: First dose: 1-1.5 mg/kg, Second dose: 0.5-0.75 mg/kg.

Advanced Airway:

 • Endotracheal intubation or supraglottic advanced airway

 • Waveform capnography or capnometry to confirm and monitor ET tube placement

 • Once advanced airway in place, give 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions

Return of Spontaneous Circulation (ROSC):

 • Pulse and pressure

 • Abrupt sustained increase in PETCO2 (typically 240 mm Hg)

 • Spontaneous arterial pressure waves with intra-arterial

Reversible Causes:

 • Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyper-kalemia, Hypothermia

 • Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis, (pulmonary), Thrombosis (coronary)



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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