•  Compressions and circulation

• Check for a pulse

• If a pulse is present, continue rescue breathing

• Reassess pulse every 2 min

• If a pulse is not present within 10 sec or pt shows signs of poor perfusion, begin chest compressions

• Chest compressions (should now be before airway/breathing)

• Initiate immediately

• Minimize interruptions between compressions

• Adult, child, and infant

• Continuous ventilation @ 8–10 breaths/min

• Continuous compressions @ 100/min

• Resume CPR immediately after defibrillation

• Complete chest recoil between compressions

• If 2 rescuers present, switch roles every 2 min to prevent fatigue

• Continue cycles of CPR until a defibrillator or additional help arrives

• Rhythm checks should not be longer than 10 sec

• Should be done after 5 cycles of CPR have been completed (2 min)

• Pulse checks should be done only if an organized rhythm is restored

• Drug administration and definitive airway placement should minimally interrupt compressions

•  Airway/breathing

• Maintain patent airway, give supplemental oxygen

• Place advanced airway

• Minimize interruptions of chest compressions during placement

• Continuous waveform capnography should be used for confirmation & maintenance of ETT placement

• After airway placed, 2 providers should administer continuous CPR (not in cycles)

• Intravascular access should be obtained

• Intravenous—peripheral or central (faster med onset, but may interfere with CPR)

• Intraosseous (IO) access—may be safely used if difficult IV access

• Endotracheal route—not desirable, last resort if IV or IO cannot be obtained

• Dose: 2–2.5 × standard IV dose diluted in 5–10 mL NS

• Drugs OK via ETT → lidocaine, atropine, epi, vasopressin, narcan

•  Defibrillation

• Prompt defibrillation is critical when a patient displays a shockable rhythm

• Initial dose for biphasic is 120–200 J; monophasic is 360 J; 2 J/kg in peds (1–8 yrs)

•  Differential diagnosis—diagnose and treat throughout resuscitation

Figure 34-1. ACLS: Adult cardiac arrest.

Figure 34-2. ACLS: Adult cardiac arrest.

Figure 34-3. ACLS: Bradycardia algorithm.

Figure 34-4. ACLS: Tachycardia with a pulse algorithm.