L Provider ~

BLS Assessment
1. Check responsiveness
2. Activate ERS/get defibrillator
3. Check breathing and pulse
StartCPR ,I
'I\

No
Pulse
Check rhythm/
shock If
0
Indicated

Pulse
Present

< 4 >
Primary Assessment
1 breath every
&seconds

Disability
Exposure

5 l
Secondary Assessment
• Focused history
• H's and T's
@I 2020 American Heart Assoc iation

Figure 7. The expanded systematic approach.

 0 Symptoms suggestive of ischemia or infarction

2
t
EMS assessment and care and hospital preparation
• Assess ABCs. Be prepared to provide CPR and defibrillation
• Admin ister aspirin and consider oxygen, nitroglycerin, and morphine if needed
• Obtain 12-lead ECG; if ST elevation:
- Notify receiving hospital with transmission or interpretation; note time of onset
and first medical contact
• Provide prehospital notif ication; on arrival, transport to ED/cath lab per protocol
• Notified hospital should mobilize hospital resources to respond to STEMI, activate STEMI
• If considering prehospital f ibrinolysis, use f ibrinolytic checklist

I
r
"
3 " .__
,
--
Concurrent ED/cath lab assessment Immediate ED/cath lab general treatment
(<10 minutes) • If 0 2 sat <90%, start oxygen at 4 L/min. titrate
• Activate STEMI team upon EMS notification • Aspirin 162 to 325 mg (if not given by EMS)
• Assess ABCs; give oxygen if needed • Nitroglycerin sublinguat or translingual
• Establish IV access • Morphine IV if discomfort not relieved by
• Perform brief. targeted history, physical exam nitroglycerin
• Review/complete fibrinolytic checklist; • Consider administration of P2Y12 inhibitors
check contraindications
• Obtain initial cardiac marker levels, complete
blood counts, and coagulation studies
• Obtain portable chest x-ray (<30 minutes);
do not delay t ransport to the cath lab

4
"
~ ECG Interpretation

< 5
ST elevation or new or
p resumably new LBBB;
0 -Non-ST-elevatio~ ACS (NSTE-A
Determine risk using validated
strongly suspicious for injury score (ie, TIMS or GRACE)
ST-elevation Ml (STEM/)

10 - - - - - -~ ~ - - - - -- - 12 - - - - - -- ~- - - - -- --
6 ST depression or dynamic T-wave Normal ECG or nondiagnostic
• Start adjunctive therapies inversion, transient ST elevation; changes in ST segment or T wave;
as indicated strongly suspicious for ischemia low-risk score
• Do not delay reperfusion and/or high-risk score Low-lintermediate-risk NSTE-ACS
High-risk NSTE-ACS

7
>12
hours
@-Troponin elevated or high-risk patient
Consider admission to
Time from onset of
Consider early invasive strategy if: ED chest pain unit or to
symptoms s12 hours?
• Refractory ischemic chest discomfort appropriate bed for
• Recurrent/persistent ST deviation further monitoring and
S12 hours • Ventricular tachycardia possible intervention
• Hemodynamic instability
8 • Signs of heart failure
Reperfusion goals: Start adjunctive therapies
Therapy defined by patient and (eg, nitroglycerin, heparin) as indicated
center criteria
See AHA/ACC NSTE-ACS Guidelines
• FMC-to-balloon inflation
(PCI) goal of s90 minutes
• Door-to-needle (flbrinolysis)
goal of 30 minutes
© 2020 American Heart Association

• • ww-w ■ v w • w w"W""rw • • w w-w a w w,r•w-ww-w ·w v ♦Y w w w w w ♦ w w rv w w w w w w-v-w-w·w-. w v w w w ww w • w w • • w w-v w w ■ T"a w w-w-w·w-. w w w w rw w v w rw-w w w W-W"W w w a w ■ 'W-W w w w w w w w w w-w w-w w-w-w-v-. w-w-w w w a w • w w w w w w-w w w w -w-w w-w rw-.w-w a w ■ ·

Figure 16. Acute Coronary Syndromes Algorithm.

 Identify signs and symptoms of possible stroke
Activate emergency response
, ..,
2 ., - - - - - - - - - - - - - -
j
\..

Critical EMS assessments and actions

• Assess ABCs; give oxygen if needed
• Initiate stroke protocol
• Perform physical exam
• Perform validated prehospital stroke screen and stroke severity tool
• Establish time of symptom onset (last known normal)
• Triage to most appropriate stroke center
• Check glucose: treat if indicated
• Provide prehospital notification; on arrival, transport to brain imaging suite
Note: Refer to the expanded EMS stroke algorithm.

, ' '
3
ED or brain imaging suite*
Immediate general and neurologic assessment by hospital or stroke team
•
Activate stroke team upon EMS notification
•
Prepare for emergent CT scan or MRI of brain upon arrival
•
Stroke team meets EMS on arrival
•
Assess ABCs; give oxygen if needed
•
Obtain IV access and perform laboratory assessments
•
Check glucose: treat if indicated
•
Review patient history, medications, and procedures
•
Establish time of symptom onset or last known normal
•
Perform physical exam and neurologic examination, including NIH Stroke Scale
or Canadian Neurological Scale
*Best practice is to bypass the ED and go straight to the brain imaging suite.
..J

, .., , r
" t--
'
. 4 V
Yes . 5 ., "I
.J
Does brain imaging • Initiate intracranial
-
, ~ show hemorrhage? hemorrhage protocol
~
'-
II, No
,r
6
"
1
' ......,
\.. .J

I Consider alteplase
--

r " 1 '

Yes 7 ~,,,,,..----'------......
' .,
. - - - - - - -----<>-' Alteplase candidate?
''
8 No
, .., ' '
Administer alteplase
9
_ _ _ _ _ _ _ __,,..J \.. I .J

Consider EVT
, • Perform CTA
• Perform CTP as indicated

, ' ',
Yes No
EVT candidate?
, .., ••
11 r------'------..,
Rapidly transport
to cath lab or transfer
to EVT-capable center
, ..., '' '
,
..,
r
-
' '
,
...,
..13.,
. 12 ~
Admit to str oke unit o r neurological ICU,
Admit to neurological ICU or transfer to higher level of care
... .,J '- .J

Figure 21. Adult Suspected Stroke Algorithm.

 0 Assess appropri.ateness for clinical condition.
Heart rate typically <50/min if bradyarrhythmia.

2
Identify and t reat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IVaccess
• 12-Lead ECG if available; don't delay therapy
• Consider possible hypoxic and toxicologic causes

3 Persistent
bradyarrhythmia causing:
4 • Hypotension?
~ onitor and observe "'\ No • Acutely altered mental status?
Doses/Details 1

• Signs of shock?
• lschemic chest discomfort? Atropine IV dose:
• Acute heart failure?
First dose: 1 mg bolus.
Repeat every 3-5 minutes.
Yes Maximum: 3 mg.
5 Dopamine IV infusion:
Usual infusion rate is
Atropine
5-20 mcg/kg per minute.
If atropine ineffective:
Titrate to patient response:
• Transcutaneous pacing taper slowly.
and/or Epinephrine IV infusion:
• Dopamine infusion
2-10 mcg per minute infusion.
or Titrate to patient response.
• Epinephrine infusion
Causes:
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
6 calcium- channel blockers,
Consider: beta blockers, digoxin)
• Hypoxia
• Expert consultation
• Electrolyte abnormality
• Transvenous pacing (eg, hyperkalemia)
© 2020 American Heart Association

. ••• ••••• ..•••••••••••••••••·•.. •• ..• .. ••• ..••••••••••·•••••••••• ..•• ..•·•••••••••••••·•••••..r• .. •••••••••••••••••••••••••• .... •••••••••••••••••••••••••••••••..r•••••••••••••••,
Figure 27. Adult Bradycardia Algorithm.
 0 A ssess appropriateness for clinical condition. Doses/Details
Heart rate typically>150/min if tachyarrhythmia. Synchronized cardloverslon:
Refer to your specific device's recommended energy level to
maxim ize first shock success.
Adenosine IV dose:
First dose: 6 mg rapid IV push; follow with NS flush.
2 Second dose: 12 mg if required.
Identify and treat underlying cause Antiarrhythmic Infusions for Stable Wlde-QRS Tachycardia
• Maintain patent airway; assist breathing as necessary Procainamide IV dose:
• Oxygen (ifhypoxemic) 20-50 mg/min until arrhythmia suppressed, hypoten sion ensues,
• Cardiac monitor to identify rhythm; monitor blood QRS duration increases >50%, or maximum dose 17 mg/kg given.
pressure and oximetry
Maintenance infusion: 1- 4 mg/min. Avoid if prolonged QT or CHF.
• IVaccess
• 12-lead ECG, if available Amlodarone IV dose:
First dose: 150 mg over 1Ominutes. Repeat as needed if V T recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.
Sotalol IV dose:
100 mg (1 .5 mg/kg) over 5 minutes. Avoid if pro longed QT.

3 Persistent
tachyarrhythmla causing:
0 -- --.
Synchronized cardloversion
• Hypotension?
•
•
Acutely altered mental status?
Signs of shock?
Yes
• • Consider sedation
If regular narrow complex,
s ~---------
If refractory, consider
•
•
lschemic chest discomfort?
Acute heart failure? L consider adenosine
-- • Underlying cause
• Need to increase
energy level for next
No cardioversion
7 • Addition of anti-
6 Yes Consider arrhythmic drug
WldeQRS?
• Adenosine only if • Expert con sultation
~0.12 second
regular and monomorphlc
• Antiarrhythmic i,nfusion
No • Expert consultation
►
8
• Vagal maneuvers (if regular)
• Adenosine (if regular)
• ~-Blocker or calcium channel blocker
• Consider expert consultation
© 2020 American Heart Association

•-w-Y •• . ....... ,. w w w-w w • ·• w w w • • w w wTw • • wv w·w-w-w-w-w w w- • • w w--w • • • • w-w rw -w- w=-w-Tw • • • • w·-w•·•• • • ww--w • • • • • • • w-w-w • 'W'"W w,r • • • • • • • • • • -w • • • • • • -.-----.,---.- • • • • • •--- • • • .............................................
Figure 30. Adult Tachycardia With a Pulse Algorithm.
 0 Tachycardia
With serious signs and symptoms
related to the tachycardia

If ventricular rate is >150/min, prepare for immediate

cardioversion. May give brief trial of medications based
on specific arrhythmias. Immediate cardioversion is
generally not needed if heart rate is s150/min.

Have available at bedside

• Oxygen saturation monitor
• Suction device
• IVline
• Intubation equipment

< >
Premedicate whenever possible*

Synchronized cardioversiont*
Refer to your specific device's recommended energy level
to maximize first shock success.

Notes

*Effective regimens have included a sedative {eg, diazepam, midazolam,

etomidate, methohexital, propofol) with or without an analgesic agent
{eg, fentanyl, morphine). Many experts recommend anesthesia if service
is readily available.

Figure 31. Electrical Cardioversion Algorithm.

 CPR Quality
Start CPR
• Give oxygen • Push hard (at least 5 cm) and
• Attach monitor/defibrillator fast (100-120/min) and allow
complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway. 30:2
compression-ventilation ratio.

~
0, VT ) Asystole/PEA • Quantitativewaveform
capnography
t - If PETCO, Is low or decreasing,
reassess CPR quality.

Shock ~ Epinephrine Shock Energy for Deflbrlllatlon

~ ASAP • Blp hasic: Manufacturer
4 10 1 - - - - - ~ - - - - - ~ recommendation (eg, initial
dose of 120-200 J); if unknown.
CPR2min CPR2min use maximum available.
• IV/IOaccess Second and subsequent doses
• IV/10 access
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
capnography • Monophaslc: 360J

Rhythm No Drug Therapy

shockable? • Epinephrine IV/I0 dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes

0f shockable? • Amiodarone IV/I0 dose:

First dose: 300 mg bolus.
Shock Second dose: 150 mg.
or
No Lidocaine IV/I0 dose:
6 First dose: 1-1.5 mg/kg.
CPR2min Second dose: 0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal Intubation or su-

< praglottic advanced airway

• Waveform capnography or cap-
nometry to confirm and monitor
>
Rhythm No ET tube placement
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breat hs/min) with continu-
Yes ous chest compressions

Shock Return of Spontaneous

0~ Circulation (ROSC)

• Pulse and blood pressure

8
• Abrupt sustained increase in
CPR2min CPR2min PETCO, (typically ~40 mm Hg)
• Amiodarone or lidocalne • Spont aneous arterial pressure
• Treat reversible causes
• Treat reversible causes waves with intra-arterial
monitoring

Reversible Causes
Rhythm Yes
• Hypovolemia
shockable? • Hypoxia
• Hydrogen ion (acidosis)
12 • Hypo-/hyperkalemia
• Hypothermia
• If no signs of return of ~ o5 or7

j
• Tension pneumothorax
spontaneous circulation • Tamponade, cardiac
(ROSC). go to 1O or 11 • Toxins
• Thrombosis. pulmonary
• If ROSC, go to • Thrombosis, coronary
Post-Cardiac Arrest Care
Consider appropriateness
of continued resuscitation
C 2020 American Heart Association

Figure 41 . Adult Cardiac Arrest Algorithm, VF/ pVT pathway.

 CPR Quality

• Push hard (at least 5 cm) and fast (100-120/min) and allow
complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Change compressor every 2 minutes. or sooner if fatigued.
Start CPR • If no advanced airway, 30:2 compression-ventilation ratio.
• Give oxygen • Quantitative waveform capnography
• Attach monitor/defibrillator - If PETC02 is low or decreasing, reassess CPR quality.

Shock Energy for Deflbrillatlon

2minutes
• Biphasic: Manufacturer recommendation (eg, initial dose of
120-200 J); if unknown, use maximum available. Second and
subsequent doses should be equivalent, and higher doses may
be considered.
• Monophaslc: 360 J
Drug Therapy
Drug Therapy
IV/10 access
Epinephrine every 3-5 minutes • Epinephrine IV/1O dose: 1 mg every 3-5 minutes
Amiodarone or lidocaine
for refractory VF/pVT • Amiodarone IV/1O dose: First dose: 300 mg bolus. Second
dose: 150 mg.
or
Consider Advanced Airway • Lidocaine IV/1O dose: First dose: 1-1.5 mg/kg. Second dose:
Quantitative waveform capnography 0.5-0.75 mg/kg.

Advanced Airway
Treat Reversible Causes
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography o r capnometry to confirm and monitor
ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds
(10 breaths/min) with continuous chest compressions

Return of Spontaneous Circulation (ROSC)

• Pulse and blood pressure

• Abrupt sustained increase in PETC02 (typically ~40 mm Hg)

< • Spontaneous arterial pressure waves with intra-arterial

monitoring >
Reversible Causes

• Hypovolemia • Tension pneumothorax

• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
• Hypo-/hyperkalemia • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
O 2020 American Heart Association

Figure 45. Adult Cardiac Arrest Circular Algorithm.

 CPR Quality
Start CPR
• Give oxygen • Push hard (at least 5 cm) and
• Attach monitor/defibrillator fast (100-120/min) and allow
complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes. or sooner if fatigued.
• If no advanced airway. 30:2
compression-ventilation ratio.
0 -VF/pVT Asystole/ PEA • Quantitative waveform
capnography

01•
- If PETCO, is low or decreasing.
reassess CPR quality.

Shock ~ Epinephrine Shock Energy for Oefibrlllatlon

~ ASAP • Blphasic: Manufacturer
10 1 - - - - - - - ' - - - - - ~ recommendation (eg, initial
dose of 120-200 J); if unknown.
CPR2 min CPR2 min use maximum available.
• IV/1O access Second and subsequent doses
• IV/1O access
• Epinephrine every 3-5 min should be equivalent. and higher
• Consider advanced airway, doses may be considered.

+ No
capnography • Monophaslc: 360 J

Drug Therapy
Rhythm
shockable? • Epinephrine IV/10 dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes • Amlodarone IV/10 dose:

01
shockable?
First dose: 300 mg bolus.
Shock Second dose: 150 mg.
or
No Lidocalne IV/10 dose:
6 First dose: 1-1.5 mg/kg.
CPR2min Second dose:0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway

< Rhythm No
• Waveform capnography or cap-
nometry to confirm and monitor
ET tube placement
>
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths/min) with continu-
Yes ous chest compressions

Shock Return of Spontaneous

0~ Circulation (ROSC)

• Pulse and blood pressure

• Abrupt sustained increase in
CPR2min CPR2 min PETCO, (typically ~40 mm Hg)
• Amlodarone or lldocalne • Spontaneous arterial pressure
• Treat reversible causes waves with intra-arterial
• Treat reversible causes
monitoring

Reversible Causes
Rhythm
Yes
• Hypovolemia
shockable? • Hypoxia
Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
Hypothermia
~ o signs of return of~ • Tension pneumothorax
spontaneous circulat ion • Tamponade, cardiac
(ROSC). go to 10 or 11 • Toxins
If ROSC, go to • Thrombosis. pulmonary
• Thrombosis, coronary
Post-Cardiac Arrest Care
• Consider appropriateness
of continued resuscitation
C 2020 American Heart Association

Figure 49. Adult Cardiac Arrest Algorithm, asystole/PEA pathway.

 0 Suspected opioid poisoning
• Check for responsiveness.
• Shout for nearby help.
• Activate the emergency response system.
• Get naloxone and an AED if available.

Yes Is the No
person breathing
normally?

3
Prevent deterioration Does the
• Tap and shout. Yes person have a pulse? No
• Open the airway and reposition. (Assess for s10
• Consider naloxone. seconds.)
• Transport to the hospital.

4 t--------'------- 6 7
Ongoing assessment of Support ventilation Start CPR
responsiveness and breathing • Open the airway and • UseanAED.
Go to 1. reposition. • Consider naloxone.
• Provide rescue breathing or • Refer to the BLS/Cardiac
a bag-mask device. Arrest algorithm.

< • Give naloxone.

>
© 2020 American Heart Association

Figure 50. Opioid-Associated Emergency for Healthcare Providers Algorithm.

 Adult Ventricular Assist Device Algorithm

Assist ventilation if necessary

and assess perfusion
• Normal skin color and temperature?
• Normal capillary refill?

Assess and treat Yes No Assess LVAD function

non-LVAD causes for altered Adequate perfusion? • Look/listen for alarms
mental status, such as • Listen for LVAD hum
• Hypoxia
• Blood glucose
• Overdose
• Stroke
Yes
MAP > 50 mm Hg and/or
LVAD functioning?
PETC02 > 20 mm Hg*?

No
Yes No
Attempt to restart LVAD
• Driveline connected?
• Power source connected?
• Need to replace system
controller?

Do not perform Perform No

< external chest
compressions
.·external chest
.compressions
LVAD restarted?
>
Yes

Follow local EMS

and ACLS protocols

Notify VAD center

I and/or medical contro)I *The PETC02 cutoff of > 20 mm Hg should be used only when an ET tube or tracheostomy
is used to ventilate the patient. Use of a supraglottic (eg. King) airway results in a falsely
' - - and transport
elevated PETC02 value.

© 2020 American Heart Association

 Continue BLS/ACLS Maternal Cardiac Arrest
• High-quality CPR
• Defibrillation when indicated • Team planning should be done in
• Other ACLS interventions collaboration with the obstetric,
(eg, epinephrine) neonatal. emergency.
anesthesiology. intensive care,
and cardiac arrest services.
• Priorities for pregnant women
Assemble maternal cardiac arrest team in cardiac arrest should include
provision of high-quality CPR and
relief of aortocaval compression with
lateral uterine displacement.
Consider etiology • The goal of perimortem cesarean
of arrest delivery is to improve maternal and
fetal outcomes.
• Ideally, perform perimortem cesarean
delivery in 5 minutes, depending on
Perform maternal interventions Perform obstetric provider resources and skill sets.
• Perform airway management interventions
• Administer 100% 0 2 , avoid • Provide continuous lateral Advanced Airway
excess ventilation uterine displacement
• Place IV above diaphragm • Detach fetal monitors • In pregnancy, a difficult airway
• If receiving IV magnesium. stop and • Prepare for perimortem is common. Use the most
cesarean delivery experienced provider.
give calcium chloride or gluconate
• Provide endotracheal intubation or
supraglottic advanced airway.
• Perform waveform capnography or
Continue BLS/ACLS Perform perimortem capnometry to confirm and monitor
cesarean delivery ET tube placement.
• High-quality CPR
• Once advanced airway is in place.
• Defibrillation when indicated • If no ROSC, complete perimortem
give 1 breath every 6 seconds
• Other ACLS interventions cesarean delivery ideally within (1 Obreaths/min) with continuous
(eg, epinephrine) 5 min after time of arrest chest compressions.

Potential Etiology of Maternal

Neonatal team to receive neonate Cardiac Arrest

A Anesthetic complications

< B Bleeding
C Cardiovascular
D Drugs
>
E Embolic
F Fever
G General nonobstetric causes of
cardiac arrest (H's and T's)
H Hypertension
© 2020 American Heart Association

Figure 57. Cardiac Arrest in Pregnancy In-Hospital ACLS Algorithm.

 1
ROSC obtained
Resuscitation is ongoing during the
2 post-ROSC phase, and many of these
Manage airway activities can occur concurrently.
Early placement of endotracheal tube However, if prioritization is

Manage respiratory parameters

t necessary, follow these steps:
• Airway management:
Waveform capnography or
Initial Start 10 breaths/min
capnometryto confirm and monitor
Stabilization Spo2 92%-98°/o
endotracheal tube placement 1

Phase PaC02 35- 45 mm Hg

• Manage respiratory parameters:

Manage hemodynamic parameters

t Titrate F102 for Sp02 92%-98°/o; start
at 10 breaths/min; titrate to Paco2 of
Systolic blood pressure >90 mm Hg 35-45mmHg
Mean arterial pressure >65 mm Hg • Manage hemodynamic parameters:
Admin ister crystalloid and/or
vasopressor or inotrope for goal
Obtain 12-lead ECG systolic blood pressure >90 mm Hg
'" _;;
or mean arterial pressure >65 mm Hg

4 Continued Managerne~t and

Consider for emergent cardiac intervention if Additional Emergent Activities
• STEM I present
These evaluations should be done
• Unstable cardiogenic shock
concurrently so that decisions on
• Mechanical circulatory support required
targeted temperature management
•,
(TTM) receive high priority as
r
5 ",, ..... cardiac interventions.
• Emergent cardiac intervention:
Follows commands?
Early evaluation of 12-lead
No Yes electrocardiogram (ECG); consider
Continued , , • , •
Management 6 ' 7 ', ' hemodynamics for decision on
' ' - ' ... ' cardiac intervention
and Additional Comatose Awake
Emergent • T TM Other critical care • TTM: If patient is not followi ng
Activities • Obtain brain CT management commands, start TTM as soon as
'-
• EEG monitoring possible; begin at 32-36°C for 24
• Other critical care hours by using a cooling device with
management feedback loop
... .J
• Other critical care management
- Continuously monitor core
, temperature (esophageal,
'•
1 9 ',
~
' rectal. bladder)
Evaluate and treat rapidly reversible etiologies
- Maintain normoxia, normocapnia.
~
Involve expert consultation for continued management
. euglycemia
- Provide continuous or intermittent
electroencephal1ogram (EEG)
monitoring
- Provide lung-protective ventilation

H's and T's

1

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
© 2020 American Heart Association

J 'W'lf WW¥ W'W"W W W'W"W'W W W"W W-W fWVW • · W'W W w•"W"W W W"W'W W W'"W . . . . . . . . W 'ii'W-W W"W W W'W W"W W W"W'W WWW ..-w ♦ WW W-WfW"W V 'W-W W"W W W"W'W- W W' W"W'W W"W"W W W-V"'W"W W'WT W'W W ♦ V W"W W'-W"W"W• W . . . . . • V W ' ♦'W"W'W'"W W'WT W'W V'"W"VW ♦ 'W"W' W-¥1'-W W"W-W' ♦ 'W'"W ♦ ♦♦ W'W

Figure 58. Adult Post-Cardiac Arrest Care Algorithm.