ACLS Cheat Sheet

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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 5-6 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.

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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-able, do you give CPR first or shock first?

Always shock first. It is important to now (if not already done by

a team member) to start...

an IV/IO access. 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 amio-darone is...

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

Dose and method of administration of lido-caine is...

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

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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

chest compressions and breathing?

Use continuous chest compressions and rate of breathing is 8-10 minute. Avoid hyperventi-lation.

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 3-5 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 <60 minute and symptomatic. First thing to consider is... airway.

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Continuously monitor and establish IV/IO

What are the S/S of poor perfusion? Acute altered mental status Ongoing chest pain

Hypotension

or Other signs of shock

What is the main criteria for action? Adequate perfusion or poor perfusion.

If adequate, then... observe/monitor

If poor, then... prepare for transcutaneous pacing.

Drugs? Atropine. Use 0.5 mg IV/IO while waiting for

paces. MAY REPEAT up to 3 mg total. Also consider, drugs? Epinephrine 2 to 10 mcg/min infusion or

Dopamine 2 to 10 mcg/kg/min infusion.

Consider... 6 H’s and 5 T’s.

Always consider expert... consultation. Tachycardia with pulses

Tachycardia for ACLS is a rate of... >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, hy-potension 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) If narrow, then check if... rhythm is regular.

If regular... Attempt vagal maneuvers

Give adenosine 6 mg fast IV/IO push (with 10 ml NS flush). If no conversion, give 12 mg fast IV/IO (with 10 ml NS flush). May repeat 12 mg once.

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If it converts, then... rhythm was probably SVT. Then observe and treat reccurance with adenosine or long act-ing AV nodal blockact-ing agents as diltiazem or B-blockers.

If does not convert, then... consider possible atrial flutter, ectopic atrial tachycardia, or junctional tachycardia. Treatment for these are... Control rate

Treat underlying cause Consider expert consultation Rate is controlled by... CCB as diltiazem

B-blockers (use precaution in pulmonary dis-ease or CHF).

If the rhythm is irregular, then... you have an irregular narrow complex tachy-cardia

This may be... atrial fibrillation or possible atrial flutter or multifocal atrial tachycardia.

Treatment is... Consider expert consultation

Rate control.

Control rate is done with... Diltiazem or B-blockers. If the rhythm is wide (>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 adeno-sine, 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.

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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)

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

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Recognizes... symptoms due to tachycardia.

Performs... immediate synchronized cardioversion.

Recognizes... VF

Immediately... resumes CPR after shocks.

Appropriate cycles... Drug/Rhythm Check/Shock/CPR

PEA Management

Recognizes... PEA

Verbalizes... potential reversible causes of PEA/asystole

(H’s and T’s)

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.

Recognizes... VF

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Appropriate... cycles Drug/Rhythm Check/Shock/CPR

PEA Management

Recognizes... PEA

Verbalizes... potential reversible causes of PEA/asystole

(H’s and T’s).