DrMKZ

Cardiac Arrest Management (Adult ACLS) Step-by-Step ✅

Based on current American Heart Association ACLS approach.

STEP 1: Recognize Cardiac Arrest

Patient is:

• Unresponsive
• No normal breathing (or only gasping)
• No pulse within 10 seconds

➡️ Activate emergency response system
➡️ Call for AED/Defibrillator

STEP 2: Start High-Quality CPR IMMEDIATELY

Chest Compressions

• Rate: 100–120/min
• Depth: 2–2.4 inches (5–6 cm)
• Allow full chest recoil
• Minimize interruptions

•Compression : Ventilation Ratio
30 : 2 if no advanced airway

•Oxygen: Give 100% oxygen

•Change compressor
Every 2 minutes

STEP 3: Attach Monitor / Defibrillator

Now determine rhythm:
TWO MAIN PATHWAYS

1. Shockable Rhythm
2. Non-Shockable Rhythm

1️⃣ SHOCKABLE RHYTHMS
VFib + Pulseless VT

• Ventricular fibrillation
• Pulseless ventricular tachycardia

🚦MANAGEMENT OF VFib / Pulseless VT

STEP 1 → DEFIBRILLATION

• Biphasic: 120–200 J
• Monophasic: 360 J

➡️ Immediately resume CPR for 2 minutes

STEP 2 → IV/IO Access

Give: Epinephrine 1 mg IV/IO every 3–5 min
Continue CPR

STEP 3 → Recheck Rhythm

‼️ If still shockable: Give second shock & Resume CPR immediately.

Then give: Amiodarone

• First dose: 300 mg IV bolus
• Second dose: 150 mg

Alternative: Lidocaine

• First dose: 1-1.5mg/kg
• Second dose: 0.5-0.75mg/kg

If Torsades de Pointes : Magnesium sulfate1–2 g IV

2️⃣ NON-SHOCKABLE RHYTHMS

PEA + Asystole
•Pulseless electrical activity
•Flatline/asystole

🚦MANAGEMENT

NO DEFIBRILLATION
Instead:

• CPR immediately
• IV/IO access
• Epinephrine ASAP: 1 mg every 3–5 min
  ➡️ Rhythm check every 2 minutes

STEP 4: Search for REVERSIBLE CAUSES

“Hs and Ts”

Hs

• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo-/Hyperkalemia
• Hypothermia

Ts

• Tension pneumothorax
• Cardiac Tamponade
• Toxins
• Thrombosis (MI)
• Thrombosis (PE)
• Trauma

STEP 5: Return of Spontaneous Circulation (ROSC)

Signs:

• Pulse returns
• BP improves
• ETCO₂ rises suddenly

👨🏼‍🔬 POST-CARDIAC ARREST CARE

• Oxygenation (SpO₂ 92–98%)
• Treat hypotension
• ECG → look for STEMI
• Temperature management
• ICU care