1. ACLS ALGORITHMS

2. Acute Pulmonary Edema / Hypotension / Shock Algorithm
Clinical signs of hypoperfusion, congestive
heart failure, acute pulmonary edema
Assess ABC’s Assess vitals
Secure airway Review history
Administer O2 Perform physical exam
Start IV 12 lead ECG, chest x-ray
Attach monitor, pulse oximetry and B/P Cuff
Figure 8
What is the nature of the problem?
Volume problem
Includes PVR problems
Pump Problem
Rate Problem
What is the BP ?
Administer
Fluids
Blood transfusions
Cause-specific interventions
Consider vasopressors
Too Slow
Go to Fig 5
Too Fast
Go to Fig 6
Systolic BP
< 70
Signs of shock
Systolic BP
mmHg
Signs of shock
Systolic BP
mmHg
No Signs of shock
Systolic BP
> 100 mmHg

3. Bradycardia Algorithm (Patient is not in Cardiac Arrest)
Assess ABC’s Assess vitals
Secure airway Review history
Administer O2 Perform physical exam
Start IV 12 lead ECG, chest x-ray
Attach monitor, pulse oximetry and B/P Cuff
Figure 5
Bradycardia, either absolute
(<60 BPM) or relative
Serious signs and symptoms?a,b
Yes No
Type II second-degree AV heart block or
Third-degree AV heart Block?e
Intervention sequence
Atropine mcg,d (I and IIa)
TCP, if available (I)
Dopamine mcg/kg/min (IIb)
Epinephrine mcg/min (IIb)
Norepinephrine 0.5 –30 mcg/min (IIb) No
Yes
Observe
Prepare for transvenous pacer
Use TCP as a bridge device

4. Tachycardia Algorithm (Patient is not in Cardiac Arrest)
Assess ABC’s Assess vitals
Secure airway Review history
Administer O2 Perform physical exam
Start IV 12 lead ECG, chest x-ray
Attach monitor, pulse oximetry and B/P Cuff
Figure 6
If ventricular rate > 150 BPM
Prepare for cardioversion
May give brief trial of Rx
Immediate cardioversion is seldom
needed for heart rates < 150 BPM
Yes
Unstable, with serious signs or symptoms?a No
Atrial Fibrillation
Atrial Flutter
Ventricular
Tachycardia (VT)
Paroxysmal
Supraventricular
Tachycardia
(PSVT)
Wide-complex
tachycardia of
uncertain type

5. Epinephrine 1 mg IV push,a,c repeat q 3 - 5 min
Pulseless Electrical Activity (PEA) Algorithm (Electromechanical Dissociation [EMD])
Figure 3
Includes
Electromechanical dissociation (EMD) Postdefibrillation idioventricular rhythms
Pseudo - EMD Bradyasystolic rhythms
Idioventricular rhythms Ventricular escape rhythms
Continue CPR / Intubate at once / Obtain IV Access
Assess blood flow using Doppler ultrasound, endtidal CO2,
echocardiography, or arterial line
Consider possible causes
Hypovolemia (volume infusion) Drug overdoses - tricyclics, digitalis
Hypoxia (ventilation) Beta-blockers, calcium channel blockers
Cardiac tamponade (pericardiocentesis) Hyperkalemia
Tension Pneumothorax Acidosis
Hypothermia ( see hypothermia algorithm) Massive acute myocardial infarction
Massive pulmonary embolism (surgery, lysine) Massive acute MI (go to Fig 9)
Epinephrine 1 mg IV push,a,c repeat q min
If absolute bradycardia (< 60 BPM) or relative bradycardia
give atropine 1 mg IV
Repeat q 3 -5 min to a total of mg/kg

6. Consider termination of efforts
Asystole Treatment Algorithm
Continue CPR
Intubate at once
Obtain IV Access
Confirm asystole in more than 1 lead
Consider possible causes
Hypoxia Pre-existing acidosis
Hyperkalemia Drug Overdose
Hypokalemia Hypothermia
Consider immediate
transcutaneous pacing (TCP)a
Figure 4
Epinephrine 1mg IV push,b,c
repeat q min
Atropine 1 mg IV push
repeat q min up to a total
of mg/kgd,e
Consider termination of efforts

7. Ventricular Fibrillation (VF) & Pulseless Ventricular Tachycardia (VT)
Figure 2
ABCs
Perform CPR until defibrillator Arrives
VF/VT present on defibrillator
Defibrillate up to 3 times if needed for persistent VF/VT
200 J, J, 360 J
Rhythm after the first 3 shocks? b
VF/VT
ROSC
PEA
Go to Fig 3
Asystole
Go to Fig 4

8. Administer Rx Class IIa
Figure 2
VF & Pulseless VT
Continue CPR
Intubate / IV Access
Epinephrine c,d
1 mg/IV
2 mg/ETT
q min
Defibrillate 360 J
within sec
Administer Rx Class IIa
probable benefit f, g
Defibrillate 360 J,
sec after Rx