48  Advanced Cardiovascular Life Support (ACLS)

Note

If no advanced airway, the ratio of compressions to ventilation (breaths) is 30:2

48.1 Tachycardia with pulse

  • If sustained VTach with a pulse and HD unstable → DC synchronized cardioversion
  • If sustained VTach with a pulse and HD stable → amiodarone (See @ref(stable-vt-vf))
  • Regular narrow QRS complex and suspect supraventricular tachycardia (@ref(supraventricular-tachycardia-svt))
    • IV adenosine
      • First dose: 6 mg rapid IV push
      • Second dose (if needed): 12 mg (up to 2x)

48.2 Pulseless Tachycardia

Pulseless VTach and hypOtensive VTach are treated like VFib
  • If VFib or pulseless VTach → DC unsynchronized cardioversion

48.3 Bradycardia with pulse

  • First line: atropine
  • If atropine is ineffective:
    • transcutaneous pacing
    • dopamine infusion
    • epinephrine infusion
  • Acute sinus bradycardia in the setting of an acute MI is usually temporary so atropine alone may be sufficient