Emergency & ACLS Reference
BLS Algorithm (Adult)
- Check scene safety
- Check responsiveness
- Activate EMS / get AED
- Check pulse and breathing (no more than 10 seconds)
- Start CPR: 30:2 ratio, rate 100–120/min, depth 2–2.4 inches
- Use AED when available
ACLS Cardiac Arrest Algorithm
Shockable (VF/pVT)
CPR → Shock → CPR 2 min → Epinephrine every 3–5 min → Shock → Amiodarone
Non-Shockable (Asystole/PEA)
CPR → Epinephrine every 3–5 min → CPR 2 min → repeat
Reversible causes (H's and T's):
- H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia
- T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary)
Code Medications
| Drug | Dose | Route | Indication |
|---|---|---|---|
| Epinephrine | 1 mg | IV/IO q3–5 min | Cardiac arrest |
| Amiodarone | 300 mg first, 150 mg second | IV | VF/pVT refractory |
| Atropine | 1 mg | IV q3–5 min | Bradycardia |
| Vasopressin | 40 units | IV (single dose) | Alternative to epinephrine |
| Adenosine | 6 mg rapid IV push, then 12 mg | IV | SVT |
| Dopamine | 5–20 mcg/kg/min | IV drip | Bradycardia, hypotension |
| Dobutamine | 2–20 mcg/kg/min | IV drip | Heart failure, cardiogenic shock |
| Norepinephrine | 0.1–2 mcg/kg/min | IV drip | Septic shock, vasodilatory shock |
Tachycardia Algorithm
Unstable (hypotension, chest pain, HF, shock): Synchronized cardioversion.
Stable:
- Narrow regular: Vagal maneuvers → Adenosine
- Narrow irregular: Rate control
- Wide regular: Amiodarone
- Wide irregular: Expert consult
Bradycardia Algorithm
- Atropine 1 mg IV
- Transcutaneous pacing
- Dopamine 5–20 mcg/kg/min
- Epinephrine 2–10 mcg/min
Rapid Response Triggers
- HR <40 or >130
- SBP <90
- RR <8 or >28
- SpO2 <90%
- Acute mental status change
- Chest pain
- New-onset seizure
- Significant bleeding
Stroke Assessment
FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911.
Door-to-needle time <60 min for tPA.