BCLS + ACLS

Basic algorithm

Step1 (Basic life support)

Check unresponsive

Primary ABCD survey:

• Airway: check oral cavity, open airway
• Breathing: check breathing
• Circulation: check circulation. Commence CPR.
• Defibrillator: attach defibrillator/monitor

Step 2

Assess/reassess rhythm and pulse

Step 3

Depends on the type of rhythm.

If VF/pulseless VT

1. Defibrillation (200J,360J, 360J first cycle, then 360J x 3 subsequent cycle)

2. CPR for 1 minutes and go back to step 2.

After 1st cycle of defibrillations, give:

• epinephrine (1mg of 1:10,000) every 3-5 minutes (e.g. once every 1 or 2 cycles)
  OR
• vasopression 40U IV (one-off) (then switch to epinephrine after 5mins)

After 2nd cycle of defibrillations, give:

• amiodarone 300mg IV (one-off)

After 3rd cycle of defibrillations, give:

• amiodarone 150mg IV (one-off topup)
  OR
• lignocaine 1.5mg/kg IV (one-off)

Consider using

• procainamide 30mg/min (upto 17mg/kg) for refractory VF
• lignocaine repeat dose (one repeat only)
• magnesium sulphate 1-2g IV (for hypomagnesemia, or Torsades de Pointes)
• bicarbonate 1mEq/kg for:
  a. preexisting hyperkalemia,
  b. preexisting acidosis,
  c. OD on TCA,
  d. OD on aspirin (to alkalinise urine)
  e. long arrest interval
  (NOT FOR RESPIRATORY ACIDOSIS)

Epinephrine is the most important drug.

If PEA

1. Look for reversible causes of cardiac arrest (5H5T)

2. Continue CPR for 3 minutes and go back to step 2

3. Give epinephrine 1mg (of 1:10,000) every 3-5 minutes

4. Give atropine 1mg every 3-5 minutes if bradycardia (max 0.04mg/kg)

5. Give bicarbonate 1mEq/kg (as per VF/VT)

If asystole

1. Look for reversible causes of cardiac arrest (5H5T)

2. Continue CPR for 3 minutes and go back to step 2

3. ?Transcutaneous pacing (apparently no evidence for it)

4. Give epinephrine 1mg (of 1:10,000) every 3-5 minutes

5. Give atropine 1mg every 3-5 minutes (max 0.04mg/kg)

6. ?Give bicarbonate (apparently no evidence for it)

Step 4 - Post-resuscitation care

Once circulation returns, start constant infusion of amiodarone 1mg/min.

Reversible causes of cardiac arrest

5 Hs:

• Hypovolemia
• Hypoxia
• Hypothermia
• Hyper/hypokalemia
• H ions (i.e. acidosis)

5Ts:

• Toxin (i.e. overdoses)
• Tamponade, cardiac
• Tension pneumothorax
• Thrombosis, pulmonary (i.e. PE)
• Thrombosis, cardiac (i.e. acute coronary syndrome)

Prolong CPR in hypothermia, submersion, drug overdose.

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Things to revise/add later: post resus management

Bibliography: Internal Medicine Oncall, ACSL 2000 (iSilo)