Advanced Cardiac Life Support - Algorithms

Algorithms

The current ACLS guidelines are set into several groups of 'algorithms' - a set of instructions that are followed to standardize treatment, and increase its effectiveness. These algorithms usually come in the form of a flowchart, incorporating 'yes/no' type decisions, making the algorithm easier to memorize.

Notes on using the ACLS algorithm

• Search for and correct potentially reversible causes of arrest, brady/tachycardia.
• Exercise caution before using epinephrine in arrests associated with cocaine or other sympathomimetic drugs. Epinephrine is not required until after the second DC shock in standard ACLS management as DC shock in itself releases significant quantities of epinephrine
• Give atropine 1 mg dose (IV) for asystole or slow PEA (rate<60/min) (No longer recommended.)
• In PEA arrests associated with hyperkalemia, hypocalcemia. or Ca2+ channel blocking drug overdose, give 10mL 10% calcium chloride (IV) (6.8 mmol/L)
• Consider amiodarone for ventricular fibrillation/pulseless ventricular tachycardia after 3 attempts at defibrillation, as there is evidence it improves response in refractory VF / VT.
• For torsades de pointes, refractory VF in patients with digoxin toxicity or hypomagnesemia, give IV magnesium sulfate 8 mmol (4mL of 50% solution)