Adult Cardiac Arrest Algorithm—2015 Update Advanced Cardiovascular Life Support ( Start CPR | + che nyoen 1 Astach monitor/firlator CPR 2 min ‘= IAQ access ccapnography ‘= Epinephrine every 3-5 min + Consider advanced airway, ccapnography CPR 2 min ‘+ Amiodarone ‘Tat reversible causes + If no signs of return of spontaneous circulation (ROSO), 90 to 10 oF 14 ++ IFROSC, go to Post-Cardiac Arrest Care 9 = ed (oazuareass) ‘= Epinephrine every 3-5 min * Consider advanced airway, American Heart Association» life is why~ + Pusha nt ites Bend anatan 00-1200 Sd lon caplet crest et + Manas torus + fr vec verte, 1 Bex compar ey ors toner ge + Ko sence say, 532 compression ersten rate + Gleriatve wavetor Seite cen "Phere cm Ha tert o improve GOR gay + itera peste Nirman pase atc) pre ct mi, arto Improve OR gy + Biphasic: Mnuiatrer ‘eoorardcton op, tal ose rian: urmrewn, ve Seconda eugequet sss ‘Sholsbe sae a ober ‘hoes may bacon. + Sinepin 1Vn0 dose: genary 35 motes + Areca NM dose rtd 30 mg bobs. ‘Sszane oom 0m. * Endoracraal tiation page adres aay + Havetom capoatepy or (aenaraty to corti and mentor + Gnoe aoranoad aay plan, (gre bah ove 8 score ctor th conruous + Pee ardor 1 Aorptsumines ines n PCO, (upeaby 280 ror + Sportansousaeral posse naves ‘ath ieanera montomns| + Mypovctenea Hypo Byregen on ais Hype-myoetaenie {+ Mponema 1 Teneo poourothore {2 Tenponado,cucac ‘Tremere, sna set 9119 Everette 8 examen vention mien BSAdult Tachycardia With a Pulse Algorithm eo eens Tod ¢ | _Assess appropisteness for cnial conition. typical init a, en Identity and treat underiying cause * Maintain patent ainway; assist breathing as necessary Persistent tachyarthythmia causing: ee ‘Synchronized Hypotension? cardioversion * Acutely altered mental status? + Signs of shock? * Ischemic chest discomfort? = Acute near failure? * IV access and 12-4ead ECO itavaiiable * Consider acienosine only it regular + lV access and 12-lead ECG if available ‘+ Vagal maneuvers ne (regs) American Heart Associations life is why~ ‘Synchronized cardioversion: Initial recommended doses: + Nasrow regular: 50-100 J + Narrow iregular: 120-260 J biphasic or 200 J monophasic + Wide regular: 100 J + Wide regular: defibritation dose (not synchronized) ‘Adenosine IV dose: First dose: 6 mg rapid IV push; follow with NS flush, Second dose: 12 mg if required. Antiarrhythmic Infusions for ‘Stable Wide-QRS Tachycardia Procainamide IV dose: 20-50 ma/min until anthythmia ‘suppressed, hypotension testes, QRS curation increases: 35084, oF maximum dose 17 mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid it prolonged QT or CHE Amiodarone IV dose: First désa: 150mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of 1 mg/min for frst 6 hours. Sotalol IV dose: +100 mg (1.5 mg/kg) over S minutes. Avoid if prolonged QT. (© 2016 Ameroan Heat AezocationAdult Bradycardia american With a Pulse Algorithm O ves... \ life is why Oe ed ‘Assess appropriateness for inical condition. Identify and treat underlying cause + Maintain patent away; assist breathing es necessery + Oxygen (t hypoxemic) * Carciac monitor to identity rythm; monitor blood pressure and aximety bradyarthythmia causing: + Hypotension? Acutely altered mental status? Doses/Details ‘Atropine IV dose: First dose: 0.5 mg bolus. Repset every 9-5 minutes. Maximum: 3 mg. Dopamine IV infusion: Usual infusion rate is 2-20 megikg per minute Tirate to patient response; taper slowly. Epinephrine IV infusion: 2:10 meg per minute infusion. irate to patient response. 15-1008 2 4) ISBN oT 81660-405-6 9/18 ©2016 Arercan Hear Assocation Printed In he USAAdult Immediate Post-Cardiac Arrest Care Algorithm—2015 Update American Heart Associations life is why tee ead Return of spontaneous circulation (ROSC) | ‘Optimize ventilation and oxygenation * Maintain oxygen saturation 29496 ‘Treat hypotension (SBP <@0 mm Hg) 190 bolus Ventilation/oxygenation: ‘Avoid excessive ventiation, ‘Start at 10 breaths/min and titrate to target PETCO, of 35-40 mm Ha, When feasible, ttrate Fo, to minimum necessary 10 achiave Spo, 20496, WV bolus: Approximately 1-2 L normal saline or lactated Ringer's Epinephrine 1 infusion 07-0.5 mog/kg per minute fi Toe edt 7-98 meg por minute) Dopamine IV infusion: 5-10 moghkg per minute Norepinephrine IV infusion: 0.1.0.5 meg/kg per minute (in 70-kg adult: 7-38 meg per minute) Pome '+ Hypovolomia + Hypoxia ‘+ Hydrogen ion (acidosis) + Hypo-shyperkalemia + Hypothermia * Tension pneumothorax ‘+ Tamponade, cardiac + Toxins ‘+ Thrombosis, pulmonary ‘+ Thrombosis, coronary 15-1008 (4014) ISENOTE-L8r6604086 6 © 2016 AmoHean Heat Asoiton Printed inte Sh YYAdult Suspected ‘American Heart Stroke Algorithm Association. life is why eke ee es Asrival © =D Arrival amin stoke Admission ‘Shours Identify signs and symptoms of possible stroke Critical EMS assessments and actions Syst AS repo Hee cain aici cay Immediate general assessment and stabilization Assess ABCs, vital signs * Perform neurologic screening ¢ Provide oxygen if hypoxemic assessment (mediate neurologic assessment by stroke team or designee Review patent History + Establish time of symptom oncet or last known normal + Perform neurologic examination (IM Stroke Seale or Consult neurologist ‘oF neurosurset + Begin stroke or hemorrhage pathway _ * Begin post-rtPA stroke pathway * Aggressively monitor. © 2018 American Heart AssocationAcute Coronary American Syndromes Algorithm— heart ah 2015 Update life is why ere ke ees ad ‘Symptoms suggestive of ischemia or infarction EMS assessment and care and hospital preparation + Monitor, support ABCs. He prepared to provide GPR and dofirilation| * Administer asprin and consider oxygen, nitroglycerin, and morphine if needed + Obtain 12-4ead EOG: i ST elevation: Nay ecling Heap with waremizsion or rtrprtation; ot time of ‘Concurrent ED assessment (<10 minutes) ‘Check vital signs; evaluate oxygen saturation + Establish IV access ‘+ Perform brit, targeted history, physical exam + Review/complete fibrinolytic checklist; JEP SSE se vel ‘ST depression or dynamic “Towave inversion; strongly suspicious for ischemia High-risk non-ST-clevation ACS (STE-ACs) ST elevation or new or presumably new LBEE; strongly suspicious for injury a i ‘SFelevation MI (STEM!) Immediate ED general treatment IFO, sat <90%%, siart oxygen at 4 Umin, irate Aspirin 160 to 225 ma (not given by EMS) + Nitroglycerin sublingual or spray + Morphine IV if ciscomfort not relieved by ritoaiycerin SST sogment or Twave | "Normal or nondlagnostic changes in Low-/intormediate-risk ACS y ‘Troponin elevated or high-risk patient Consider eary invasive strategy if: * Reactor ischemic chest discomfort + Recutrent/persisent ST deviation Consider admission to ED chest pain unit or to appropriate bed for further monitoring and 212 * Vortnoulrtachyoarcia Time trom onset of MOUS, smodynamic instability | symptoms =12 hours? ¢ Signs of hear falure ‘Start adjunctive therapies 12 hours as “Therapy defined by patient and center eter + Door-to-balloonifltion 15-1008 9 of ‘SBN97O-1-51668-408-8 9/18 © 2016 Amarican Hear ASSecaton Pinedinthe USABLS Healthcare Provider ‘American Adult Cardiac Arrest Heart Associations Algorithm—2015 Update life is why ern kee ee Victim is unresponsive. Shout for nearby help. Activate emergency response system mobile devies (if appropriate). ul Provide rescue breathing: 1 breath every 6-6 secands, or ‘about 10-12 breaths/min. * Activate emergency response Look for no breathing ‘system (ifnot akeady cone) ‘or only gasping and check after 2 minutes. pulse (simultaneously). * Continue rescue breathing: Is pulse dofinitely fot within 10 seconds? Monitor unt No breathing or only gasping, no pulse By this time in all scenarios, emergency = response system or backup is activated, ‘and AED and emergency equipment are retrieved or someone is retrieving them. Begin cycies of ‘30 compressions and 2 breaths. Use AED as soon as its available Check rhythm, ‘Shookable rhythm? Give 1 shock. Resume CPR immediately for about 2 minutes (until prompted by AED to allow rhythm check). Continue until ALS providers take Rosume CPR immediately for about 2 minutes (until prompted by AED to allow rhythm check). Continue until ALS providers take over or victim starts to (© 2016 Anercan Heat Assocation