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ACLS 2020

Updated: Feb 27, 2021

· Rapid Response Team purpose - to improve patient outcomes by identifying and treating early clinical deterioration and providing immediate intervention for life-threatening conditions.

· Team Dynamics – Team leaders should clearly designate tasks. Every team member should understand their role and verbally acknowledge when orders are received, and actions are taken.

· Basic Life Support (CPR) – Agonal gasps are not respirations, limit pulse check to 5-10 seconds, immediately resume compressions after defibrillation, rate is 100-120 compressions per minute.

· Ventricular Fibrillation/Pulseless Ventricular Tachycardia – BLS, Defibrillation, Epinephrine 1 mg every 3-5 minutes, Amiodarone 300 mg or Lidocaine 1.0-1.5 mg/kg, consider advanced airway with capnography, consider H’s and T’s.

· Asystole/Pulseless Electrical Activity – BLS, Epinephrine 1 mg every 3-5 minutes, treat the cause – IVF bolus, airway, needle decompression, pericardiocentesis, rewarm, sodium bicarbonate for the H’s and T’s.

· Return of Spontaneous Circulation (ROSC) – Optimize ventilation and oxygenation, increase BP with IVF’s and vasopressor infusions (Epinephrine, Dopamine, or Norepinephrine), coronary reperfusion, consider targeted temperature management at 32-36 degrees Celsius for at least 24 hours, advanced critical care.

· Bradycardia – Treat the cause, Atropine 1 mg every 3-5 minutes up to maximum of 3 mg, consider pacing, Dopamine 5-20 mcg/kg/min infusion or Epinephrine 2-10 mcg/min infusion.

· Tachycardia – Stable narrow-complex – obtain 12 lead ECG, consider vagal maneuvers, Adenosine 6 mg IVP and may repeat at 12 mg, consider beta-blocker or calcium channel blocker. Stable wide-complex tachycardia – consider Adenosine if regular and monomorphic, consider Procainamide 20-50 mg/minute up to 17 mg/kg max, Amiodarone 150 mg over 10 minutes, or Sotalol 100 mg over 5 minutes. Unstable tachycardia – synchronized cardioversion.

· Acute Coronary Syndromes (ACS) – Obtain 12 lead ECG, oxygen, Aspirin 160-325 mg, Nitroglycerin SL or spray, Morphine IV if discomfort not relieved with NTG, reperfusion with PCI or fibrinolysis.

· Suspected Stroke – Establish time of symptom onset, blood glucose, NIH Stroke Scale, emergent CT or MRI of brain to rule out hemorrhage, check for fibrinolytic exclusions, control BP, repeat neuro exam to see if deficits are improving, mechanical thrombectomy or rTPA for ischemic stroke and monitor for neurologic deterioration, BP monitoring.

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