Acls bsc nursing note

1. ACLS- ALGORHYTHM

2. 2020 Cardiac Arrest Algorithm

3. ACLS- ALGORHYTHM
• The Cardiac Arrest Algorithm takes its place as
the most important algorithm in the ACLS
Protocol. There are 4 rhythms that are seen with
pulseless cardiac arrest. They each will be
reviewed throughout this section of the course
guide.
• These four rhythms are pulseless ventricular
tachycardia (VT), ventricular fibrillation (VF),
asystole, and pulseless electrical activity (PEA).

4. ACLS- ALGORHYTHM
• The majority of patients that experience
sudden cardiac arrest will be treated with the
Cardiac Arrest Algorithm. Therefore, mastery
of this algorithm is very important. There are 2
branches of the Cardiac Arrest Algorithm, the
left, and right branch.

5. Medications for Cardiac Arrest
• There are 3 medications that will be focused
on within the Cardiac Arrest
Algorithm, epinephrine, amiodarone, and
Lidocaine. Magnesium will be mentioned
briefly.

6. Epinephrine
Epinephrine is the primary drug used in the cardiac arrest
algorithm. It is used for its potent vasoconstrictive
effects and also for its ability to increase cardiac output.
Epinephrine is considered a vasopressor.
• Indications for Cardiac Arrest
• Vasoconstriction effects: epinephrine binds directly to
alpha-1 adrenergic receptors of the blood vessels (arteries
and veins) causing direct vasoconstriction, thus, improving
perfusion pressure to the brain and heart.
• Cardiac Output: epinephrine also binds to beta-1-
adrenergic receptors of the heart. This indirectly improves
cardiac output by:

7. Epinephrine
• Increasing heart rate
• Increasing heart muscle contractility
• Increasing conductivity through the AV node
Routes
• During ACLS, epinephrine can be given 3 ways: intravenous; intraosseous,
and endotracheal tube. The primary method used is intravenous. When
given intravenously, always follow the IV push with a 20 ml normal saline
flush.
Dosing
• Intravenous Push/IO: 1mg epinephrine IV is given every 3-5 minutes.
• Note: There is no clinical evidence that the use of epinephrine when used
during cardiac arrest, increases rates of survival to discharge from the
hospital. However, studies have shown that epinephrine and vasopressin
improve rates of ROSC (return of spontaneous circulation).

8. AMIADRONE
Indications for ACLS
Amiodarone is an antiarrhythmic that is
used to treat both supraventricular
arrhythmias and ventricular arrhythmias.

9. Amiodarone
• The mechanism of action of amiodarone remains unknown, but within the
framework of ACLS, amiodarone is used primarily to treat ventricular fibrillation
and ventricular tachycardia that occurs during cardiac arrest and is unresponsive to
shock delivery, CPR, and vasopressors.
• Amiodarone should only be used after defibrillation/cardioversion and
epinephrine have failed to convert VT/VF.
Route
• Amiodarone can be administered by intravenous or intraosseous route.
Dosing
• The maximum cumulative dose in a 24 hour period should not exceed 2.2 grams.
• Within the VT/VF pulseless arrest algorithm, the dosing is as follows:
300mg IV/IO push → (if no conversion) 150 mg IV/IO push → (after
conversion) Infusion #1 360 mg IV over 6 hours (1mg/min) → Infusion #2 540 mg
IV over 18 hours (0.5mg/min)
• Infusions exceeding 2 hours must be administered in glass or polyolefin bottles
containing D5W.
• Amiodarone should only be diluted with D5W and given with an in-line filter.

10. Lidocaine
• Lidocaine is an antiarrhythmic that can also be
used and is considered equivalent to
amiodarone in the treatment of ventricular
fibrillation or pulseless ventricular tachycardia.

11. Lidocaine
Dosing
Provide an initial dose of 1-1.5 mg/kg IV or
IO. If pVT or VF persists the lidocaine may
be repeated at 0.5-0.75 mg/kg over 5 to 10
minute intervals.
The maximum total dosage of lidocaine is 3
mg/kg.

12. Magnesium Sulfate
Magnesium sulfate can be used during cardiac
arrest primarily to treat torsades de pointes
that is caused by a low serum magnesium
level.
• Dosing
• Provide an initial dose of 1-2 grams IV or IO
diluted in at least 10 ml of NS. Give the dose
over 5 minutes.