ACLS Cheat Sheet

ACLS Cheat Sheet
Basic BLS
You see a man collapse at a grocery store. Shake and shout. Establish unresponsiveness.
What is the first thing you do?
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, open the airway and check for breathing.
you would...
How do you do this? Explain difference in If there is no trauma or suspected trauma,
trauma no 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.
How many cycles of CPR? 5 cycles.
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 biphasic = 200J
give... monophasic = 360J
After the shock is delivered you... IMMEDIATELY start CPR
If you have a shock device immediately avail- Always shock first.
able, do you give CPR first or shock first?
It is important to now (if not already done by an IV/IO access.
a team member) to start...
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- in VT/VF 300 mg IV/IO once, may consider a
darone is... second dose of 150 mg.
Dose and method of administration of lido- 1 to 1.5 mg/kg IV/IO once, may repeat 0.5 to
caine is... 0.75 mg/kg second dose.
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 Use continuous chest compressions and rate
chest compressions and breathing? 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.
If needed, give... oxygen.
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.
Does the rhythm convert? Consider expert consultation.
If it converts, then... rhythm was probably SVT. Then observe and
treat reccurance with adenosine or long act-
ing AV nodal blocking 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.
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
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
Recognizes... unstable tachycardia.
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
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
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.

ACLS Cheat Sheet

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