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Advanced Cardiac Life Support

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  • Presumption: Out-of-hospital cardiac arrest with minimal resources
  • Check pulse, if pulseless
  • Begin CPR
  • Attach monitor/defibrilator
  • Rhythm shockable?
  • Give oxygen if available
  • Definitive treatment is transfer to nearest emergency department

V-Fib and Pulseless V-Tach (Shockable)

ACLS Algorithm
  • Shock as quickly as possible and resume CPR immediately after shocking
    • Biphasic - 200J
    • Monophasic - 360 J
  • Give Epinephrine 1mg if (shock + 2min of CPR) fails to convert the rhythm
  • Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
    • 1st line: Amiodarone 300mg IVP with repeat dose of 150mg as indicated
    • 2nd line: Lidocaine 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min
    • Polymorphic V-tach: Magnesium 2g IV, followed by maintenance infusion

Asystole and PEA (Non-Shockable)

Mechanism of PEA

Treatable ACLS Conditions (H's and T's)

PEA Evaluation by QRS

Differential based on QRS being narrow or wide and aided by ultrasound

QRS Narrow

QRS Widened


  • A: Adjunct - Place oropharyngeal airway
  • B: Breathing - Attach to bag valve mask (BVM)
  • C: Compressions - Switch out providers q pulse check (ever 2 minutes)
  • D: Defibrillation
    • May be ok to shock during compressions if wearing gloves and using biphasic device[1]
    • Precharge prior to pulse & rhythm check to increase overall compression time
  • E: Exposure
  • Other
    • Consider placing IO if unable to obtain IV access
    • Use ultrasound to evaluate for possible correctable etiologies

See Also


  1. Lloyd MS, Heeke B, Walter PF, and Langberg JJ. Hands-on defibrillation: an analysis of current flow through rescuers in direct contact with patients during biphasic external defibrillation. Circulation. 2008; 117:2510-2514.
Created by:
John Kiel on 29 January 2020 00:33:45
Last edited:
29 January 2020 00:54:42