9. Protocol
9.1. BCLS + ACLS

BCLS + ACLS

Basic algorithm

Step1 (Basic life support)

Check unresponsive

Primary ABCD survey:

Step 2

Assess/reassess rhythm and pulse

Step 3

Depends on the type of rhythm.

If VF/pulseless VT

1. Defibrillation (200J,360J, 360J first cycle, then 360J x 3 subsequent cycle)

2. CPR for 1 minutes and go back to step 2.

After 1st cycle of defibrillations, give:

After 2nd cycle of defibrillations, give:

After 3rd cycle of defibrillations, give:

Consider using

Epinephrine is the most important drug.

If PEA

1. Look for reversible causes of cardiac arrest (5H5T)

2. Continue CPR for 3 minutes and go back to step 2

3. Give epinephrine 1mg (of 1:10,000) every 3-5 minutes

4. Give atropine 1mg every 3-5 minutes if bradycardia (max 0.04mg/kg)

5. Give bicarbonate 1mEq/kg (as per VF/VT)

If asystole

1. Look for reversible causes of cardiac arrest (5H5T)

2. Continue CPR for 3 minutes and go back to step 2

3. ?Transcutaneous pacing (apparently no evidence for it)

4. Give epinephrine 1mg (of 1:10,000) every 3-5 minutes

5. Give atropine 1mg every 3-5 minutes (max 0.04mg/kg)

6. ?Give bicarbonate (apparently no evidence for it)

Step 4 - Post-resuscitation care

Once circulation returns, start constant infusion of amiodarone 1mg/min.

Reversible causes of cardiac arrest

5 Hs:

5Ts:

Prolong CPR in hypothermia, submersion, drug overdose.


Things to revise/add later: post resus management

Bibliography: Internal Medicine Oncall, ACSL 2000 (iSilo)

About
Created20031125
Updated20031201


Table of contents  | Bibliography  | Index