1) Start CPR & Attach Defibrillator
- Push hard/fast with minimal interruptions; attach monitor/defibrillator and give oxygen.
- Assess rhythm quickly: is it shockable?
Tip: Rotate compressors every 2 min or sooner if fatigued; use capnography to gauge quality and detect ROSC.
2) Shockable Rhythm: VF or pVT
Cycle
- Deliver a shock ➜ resume CPR 2 min immediately.
- During CPR: obtain IV/IO access, consider advanced airway, monitor capnography.
- Give epinephrine every 3–5 min.
- After the next shock, give amiodarone or lidocaine.
- Recheck rhythm after each 2-minute cycle; repeat as indicated.
Why
VF/pVT are defibrillation-responsive. Early high-quality CPR and timely shocks improve the odds of ROSC.
3) Non-Shockable Rhythm: Asystole or PEA
Cycle
- Resume CPR 2 min immediately; obtain IV/IO access.
- Give epinephrine every 3–5 min as soon as possible.
- Consider an advanced airway and capnography.
- Search for reversible causes throughout (see Hs & Ts).
Why
Asystole/PEA do not benefit from shocks; focus is on circulation, vasopressors, and fixing the underlying problem.
CPR Quality: What “Good” Looks Like
- Depth: at least 5 cm (2 in) on an adult; rate 100–120/min.
- Allow full recoil; limit pauses; change compressor every 2 min.
- Ventilate to avoid hyperventilation; use waveform capnography when available.
If ETCO₂ is low or decreasing, reassess quality and seek reversible causes.
Shock Energy (Defibrillation)
- Biphasic: Follow device recommendation; if unknown, start around the manufacturer’s default and escalate.
- Monophasic: 360 J for subsequent shocks.
Pearl: Minimize pre- and post-shock pauses—charge during compressions and shock within seconds of rhythm check.
Drug Therapy
Epinephrine IV/IO
- 1 mg every 3–5 min during arrest (both shockable and non-shockable paths).
Antiarrhythmic (Shockable)
- Amiodarone IV/IO: First dose 300 mg bolus; second dose 150 mg.
- or Lidocaine IV/IO: First dose ~1–1.5 mg/kg; second dose ~0.5–0.75 mg/kg.
Dose ranges and exact sequences vary by device/protocol—use your local guidance.
Advanced Airway
- Endotracheal or supraglottic airway when appropriate; confirm with waveform capnography.
- Once secured, ventilate about 1 breath every 6 sec with continuous chest compressions.
Return of Spontaneous Circulation (ROSC)
- Check pulse and blood pressure; ETCO₂ rise can suggest ROSC.
- Target oxygenation/ventilation, consider 12-lead ECG, treat hypotension, and begin post–cardiac arrest care pathway.
Sustained improvement in blood pressure, abrupt ETCO₂ increase, and awakening signs are positives—transition to post-arrest care.
Reversible Causes — Hs & Ts
Hs
- Hypoxia
- Hypovolemia
- Hydrogen ion (acidosis)
- Hypo/Hyperkalemia
- Hypothermia
- Hypoglycemia (consider)
Ts
- Tension pneumothorax
- Cardiac tamponade
- Toxins
- Thrombosis (pulmonary)
- Thrombosis (coronary)
Remember: Treating an H or T may be the difference between ongoing arrest and ROSC. Keep searching every cycle.
Cited Keywords & Referral Links
Every keyword links either to the main website or a related post on gyathshammha.com.
Bottom line
High-quality CPR, quick rhythm categorization, timely shocks for VF/pVT, appropriate epinephrine and antiarrhythmics, and relentless search for reversible causes form the backbone of ACLS cardiac arrest care.
This guide mirrors common educational teaching points and is substitute for current guidelines or medical advice.
