ACLS Protocols Summary

Overview

This lecture reviews advanced cardiac life support (ACLS) protocols, including cardiac arrest management, arrhythmia interventions, post-cardiac arrest care, and effective CPR practices.

Cardiac Arrest Initial Actions

• Begin chest compressions at a rate of at least 100 per minute when a patient is unresponsive, not breathing, and has no pulse.
• Check all AED connections and reanalyze rhythm if the AED does not promptly analyze.
• Resume chest compressions immediately when a pulse is absent and the ECG shows asystole or PEA.
• Minimize interruptions in chest compressions to 10 seconds or less.

Arrhythmia and Rhythm Management

• Obtain a 12-lead ECG for chest pain or suspected arrhythmias.
• Preferred IV access for epinephrine is peripheral IV.
• Administer 1 mg epinephrine during pulseless cardiac arrest.
• Use adenosine 6 mg IV push for narrow complex tachycardia unresponsive to vagal maneuvers; second dose is 12 mg.
• Synchronized cardioversion is indicated for unstable supraventricular tachycardia.
• For refractory ventricular fibrillation, administer amiodarone 300 mg IV.
• Vagal maneuvers are first for stable SVT; adenosine next if ineffective.

Effective CPR and Ventilation

• High-quality compressions require complete chest recoil and switching providers every 2 minutes.
• Allow continuous compressions with 10 ventilations/min if an advanced airway is in place.
• Effective CPR: PETCO₂ ≥ 10 mmHg.
• Ventilation for respiratory arrest with pulse: one breath every 5-6 seconds.
• Ventilation for cardiac arrest with advanced airway: 8-10 breaths/min.

Post-Cardiac Arrest and Emergency Care

• Use quantitative capnography to monitor CPR quality and confirm correct airway placement.
• Target PETCO₂ after ROSC: 35-40 mmHg; target minimum systolic BP: 90 mmHg.
• Initial post-arrest priority: optimize ventilation and oxygenation.
• 1-2 L normal saline or Ringer's lactate for hypotension post-ROSC.

Emergency Medications & Interventions

• Atropine (0.5 mg) for bradycardia; if ineffective, dopamine 2-10 mcg/kg/min.
• First intervention for bradycardic, apneic patient: airway maneuvers and assist ventilation.
• Synchronized cardioversion for wide complex tachycardia with instability.

Stroke and Special Situations

• Use the Cincinnati Prehospital Stroke Scale for suspected stroke.
• If CT unavailable, divert stroke patients to a capable hospital.
• Terminate efforts if rigor mortis is present.

Key Terms & Definitions

• ROSC — Return of Spontaneous Circulation.
• PETCO₂ — Partial pressure of end-tidal carbon dioxide; monitors effectiveness of CPR.
• PEA — Pulseless Electrical Activity: organized ECG rhythm without a pulse.
• Synchronized Cardioversion — Shock delivered in sync with heart rhythm for tachyarrhythmias.

Action Items / Next Steps

• Practice rhythm recognition and ACLS medication dosing.
• Review CPR quality metrics and airway management techniques.
• Complete assigned ACLS algorithm readings.