ACLS Algorithms

This page was created some many years ago (around 2001?) and was based on the older, now out-of-date algorithms. Some of the original info came from some of the sites below, as well as the now-defunct acls2000.org. However, current information is available at the sites listed below:



1 Survey Tachycardias:
2 Survey
Asystole
Bradycardia
PEA
Drugs Unstable VT/VF
Classes (Sources)

Home-Amb-Card-Crit-Neuro-OB-Orth-Pain-Ped-Reg-Tran-Vasc-Misc


 
 

Primary Survey


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Secondary Survey

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Asystole

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Bradycardia

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Tachycardias

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Atrial fibrillation/flutter

Category 1. Normal EF


Category 2. EF< 40% or CHF


Category 3.  WPW A fib

Note: new ALCS does not allow mixing antiarrhythmics for A fib/flutter.

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Narrow-Complex SVT

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PSVT
EF normal

EF < 40%, CHF Back to Tachycardias
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MAT

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Junctional

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Wide-Complex Tachycardia, Unknown Type

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Stable VT

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Cardioversion

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PEA

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Unstable VT/VF

* Or equivalent biphasic shocks (150J-150J-150J). Biphasic refers to pattern of energy wave, which is first positive then negative, i.e. in opposite direction (vs. only positive in traditional monophasic shocks). It requires less energy to achieve equivalent results. Lower energy requirements = smaller, lighter, cheaper, longer-lasting defibrillators. All new ICDs, for example, are biphasic. Newer defibrillators also monitor impedence, and compensate for changes. Success rates may be higher with impedence-compensated biphasic defibrillation. See this AHA site for details.

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ACLS Drugs
adenosine: 6-12 mg iv push with saline flush q 5 min
amiodarone:

  • Non-cardiac arrest
  • atropine: 0.5-1 mg, up to 0.04 mg/kg
    epinephrine: 1 mg q3-5 min iv
    diltiazem: ibutilde: lidocaine: magnesium sulfate: 1-2g over 5-60 min
    procainamide: vasopressin: 40 IU x 1 dose only (for pulseless VT/VF)
    verapamil: 2.5-5-10 mg bolus

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    Class Definitions: I  II  III  Indeterminant
    Class I

  • Definitely recommended. Definitive, excellent evidence provides support.
  • Definition
  • Class I interventions are always acceptable, unquestionably safe, and definitely useful.
  • Proven in both efficacy and effectiveness.**
  • Must be used in the intended manner for proper clinical indications
  • Required Evidence
  • One or more Level 1 studies are present (with rare exceptions).
  • Study results are consistently positive and compelling.
  • Class IIa and IIb Class IIa Class IIb Class III Class Indeterminant **Efficacy versus effectiveness. Evidence-based medicine draws sharp distinctions between efficacy and effectiveness, terms that initially seem synonymous. Drugs and other interventions may produce a significant level of benefit in tightly designed, closely controlled, and rigidly executed laboratory or clinical trials. These trials are a measure of efficacy--under the rigorous conditions of a controlled clinical study, the intervention "seems to work." When applied in actual practice, however, the intervention does not perform nearly as well. Effectiveness is the degree to which the intervention continues to produce positive benefits when used as intended in clinical practice--in the "real world." To communicate clearly, the term useful clinically is used to mean effectiveness.

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