Doses/Details for the Cardiac Arrest Algorithms

Q: How should CPR quality be managed in the cardiac arrest algorithm?

Push hard (at least 5 cm) and fast (100-120/min), allow complete chest recoil, minimize interruptions, avoid excessive ventilation, and change the compressor every 2 minutes. If PETCO₂ is very low or intra-arterial relaxation pressure is reduced, attempt to improve CPR quality.

Q: What defibrillation shock energies are recommended?

For biphasic defibrillation, use the manufacturer’s recommendation (e.g., an initial 120-200 J); if unknown, use the maximum available. For monophasic, use 360 J, and give higher doses for subsequent shocks when appropriate.

Q: What are the absolute contraindications to fibrinolytic therapy in STEMI?

Absolute contraindications include any prior intracranial hemorrhage, known malignant intracranial neoplasm, ischemic stroke within 3 months (with an exception for acute ischemic stroke within 3 hours), suspected aortic dissection, active bleeding or bleeding diathesis, and significant closed head/face trauma within 3 months.

Sep 23, 2026

Uploaded by Rizky

Quick-reference clinical guidance for advanced cardiac life support, focusing on cardiac arrest management doses and algorithm steps. Covers CPR quality priorities including compression rate/depth, minimizing interruptions, avoiding excessive ventilation, and using quantitative waveform capnography and intra-arterial pressure when available. Provides ROSC monitoring indicators, defibrillation shock energy recommendations for biphasic and monophasic devices, reversible causes, and standard drug therapy dosing for epinephrine and antiarrhythmics. Includes STEMI fibrinolytic checklists and contraindications, plus a suspected stroke algorithm using the Cincinnati Prehospital Stroke Scale.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Doses/Details for the Cardiac Arrest Algorithms

CPR Quality and Advanced Airway

Return of Spontaneous Circulation (ROSC)

Shock Energy for Defibrillation

Reversible Causes

Drug Therapy

Contraindications for Fibrinolytic Use in STEMI (ACC/AHA 2007)

Absolute Contraindications

Relative Contraindications

Suspected Stroke Algorithm

Cincinnati Prehospital Stroke Scale

# Doses/Details for the Cardiac Arrest Algorithms Cardiac Arrest Algortm-2018 Updat | CPR Quality | Advanced Airway | | --- | --- | | ·Push hard (at least 5 cm [2 inches])
and fast(100-120/min)and allow
complete chest recol.
·Minimize interruptions in
compressions.
·Avoid excessive ventilation.
·Change compressor every 2 minutes,
or sooner if facigued.
● If no advanced airway,30:2
compression-ventilation ratio.
·Quantitative waveform capnography
-If PETCO₂<10 mm Hg,attempt
to improve CPR quality.
·Intra-arterial pressure
-If relaxation phase(diastolic)
pressure <20 mm Hg,attempt
to improve CPR quality. | ·Endotracheal intubation or
supraglottic advanced airway
·Waveform capnography or
capnometry to confirm and
monitor ET tube placement
·Once advanced airway in place,
give 1 breath every 6 seconds
(10 breaths/min)with continuous
chest compressions | | | Return of Spontaneous
Circulation (ROSC) | | | ·Pulse and blood pressure
·Abrupt sustained increase in
PETCO₂(typically ≥40 mm Hg)
·Spontaneous arterial pressure
waves with intra-arterial
monitoring | | Shock Energy for Defibrillation | | | ·Biphasic:Manufacturer
recommendation (e.g.,initial
dose of 120-200 J);if unknown,
use maximum available,
Second and subsequent doses
should be equivalent,and
higher doses may be considered.
·Monophasic:360J | | | | Reversible Causes | | | ·Hypovolemia
·Hypoxia
·Hydrogen ion(acidosis)
·Hypo-/hyperkalemia
·Hypothermia
·Tension pneumothorax
·Tamponade,cardiac
·Toxins
·Thrombosis,pulmonary
·Thrombosis,coronary | | Drug Therapy | | | ·EpinephrineIV/IO dose:
1 mg every 3-5 minutes
·Amiodarone IV/IO dose:
First dose:300 mg bolus.
Second dose:150 mg.
-OR-
·Lidocaine IV/IO dose:
First dose:1-1.5 mg/kg.
Second dose 0.5-0.75 mg/kg. | | | | | ACLS Cardiac Arrest Circular Algorithm-2018 Update Arrhythmias,andTheir Treatment Fibrinolytic Checklist for STEMIStep 1Step 2 Systolic BP>180 to 200 mmHg or diastolic BP>100 to 110 mm HgO YESONORight vs let arm systolic BP difference >15mm HgO YESHistory of structural central nervous system diseaseO YESO NO Significant closed head/facial traurna within the previous 3 monthsO YESO NOStroke>3 hours or<3 monthsO YESO NORecent(within 2-4 weeks)major trauma,surgery (including laser eyesurgery),GI/GU bleedO YESAny history of intracranial hemorrhageO YESBleeding,clotting problem,or blood thinnersO YESPregnant femaleO YESO NOSerious systemic disease (e.g,advanced cancer,severe liver or kidney disease)O NO Is patient at high risk? If ANY one of the following is checked YES, Step 3 consider transfer to PCl facility. Heart rate 2100/min AND systolic BP<100 mm HgOYES ONOPulmonary edema (rales)OYES ONOSigns of shock (cool,clammy)O YES O NOContraindications to fibrinolytic therapyOYESt ONORequired CPROYES O NO Contraindcations for fibinotytic use in STEMI areviewed as advisory forclinical decislon making and may not be allinclusiveor defnitive.These convaindlcationsare consistent with the 2004 ACCIAHA Guidelines for the Managemient of Patents WithST-Eevabon Myocardlal nlarction. Conslder transport to prinary PC facity as destlnation hospital. ## Contraindications for fibrinolytic use in STEMI consistent withACC/AHA 2007 Focused Update ### Absolute Contraindications ·Any prior intracranial hemorrhage ·Known structural cerebral vascular lesion (e.g.,arteriovenousmalformation) ·Known malignant intracranial neoplasm(primary ormetastatic) ·Ischemic stroke within 3 months EXCEPT acute ischemicstroke within 3 hours ·Suspected aortic dissection ·Active bleeding or bleeding diathesis(excluding menses) ·Significant closed head trauma or facial trauma within 3months ### Relative Contraindication

FAQs

How should CPR quality be managed in the cardiac arrest algorithm?

Push hard (at least 5 cm) and fast (100-120/min), allow complete chest recoil, minimize interruptions, avoid excessive ventilation, and change the compressor every 2 minutes. If PETCO₂ is very low or intra-arterial relaxation pressure is reduced, attempt to improve CPR quality.

What defibrillation shock energies are recommended?

For biphasic defibrillation, use the manufacturer’s recommendation (e.g., an initial 120-200 J); if unknown, use the maximum available. For monophasic, use 360 J, and give higher doses for subsequent shocks when appropriate.

What are the absolute contraindications to fibrinolytic therapy in STEMI?

Absolute contraindications include any prior intracranial hemorrhage, known malignant intracranial neoplasm, ischemic stroke within 3 months (with an exception for acute ischemic stroke within 3 hours), suspected aortic dissection, active bleeding or bleeding diathesis, and significant closed head/face trauma within 3 months.

Sep 23, 2026

Uploaded by Rizky