ACLS Algorithm

September 14, 2015

The ACLS Algorithm can get very confusing. I've put together some study tips to help manage some of the headache. 


Study Tips for the 10 core cases:


Respiratory Arrest


Here you find a patient who has a pulse (Great! That means NO CPR right? )


So here’s what we’re looking for:

  • Successfully carry out the BLS primary survey.

  • After determining the patient is not breathing begin breathing for them.

  • Manage the airway.

  • Begin working on the ACLS secondary survey.

  • If you can nail those, this skill set will be under your thumb.


VF treated with CPR and AED


Ah yes, CPR. What we’re looking for here is:


  • You can effectively assess and treat your ABC’s.

  • Properly attach and AED.

  • Deliver a shock and begin High Quality CPR immediately after.


VF/Pulseless VT


 The infamous VF algorithm! Here’s what you need to know:


  • Your treatment priorities: 1) High Quality CPR 2) Defibrillation 3) Drug deliverance 4) Intubation.

  • Know your drugs for this algorithm as well as their intervals (hint: there are a total of 5 drugs that may be given during this algorithm)

  • Know your energy setting and method of deliver (hint: defibrillation)

  • Your treatment sequence should be:

CPR (check a pulse)->defibrillation-> CPR (5 rounds) and push drug->check a pulse->defibrillation->CPR (5 rounds) and push drug->and so on and so on


Pulseless Electrical Activity


 H’s and T’s


  • It’s a pulseless algorithm so of course CPR is going to be the priority.

  • Look for the cause (H’s and T’s) of the arrest. Note to self, there will be a cause in our scenarios and until you find it, you’ll continue finding your patient pulseless!

  • Know your drugs for this algorithm (saline is considered a drug!)




The final frontier.


  • Yes, asystole is a terminal rhythm, but does that mean that we never get people back from asystole?

  • Focus on CPR.

  • Know your drugs.

  • H’s and T’s

  • Know when to call the code.


Acute Coronary Syndrome


He’s having the big one!


  • Recognition is key. You’ll need to be able to recognize the signs and symptoms of a heart attack.

  • 12 lead, IV

  • MONA: Morphine, Oxygen, Nitroglycerin (contraindication?) , Aspirin (Indications? Contraindications?) (Allergies? Hypotensive?)

  • What’s the difference between a right sided MI and a left sided MI

    • How do we treat these differently

  • What about Atropine in the onset of a bradycardic MI?





Great he has pulse, but now what do we do?


  • Determine if your patient is unstable vs. stable/symptomatic.

  • One word: IV02MONITOR (meaning in one word you should order an IV to be established, place patient on oxygen and monitor ECG.)

  • Stable patients get drugs.

  • Unstable patients get electricity. Consider other treatments if TCP fails.

Sinus Bradycardia is not the only rhythm that will produce bradycardia, know your blocks!

1’                     2’ Type I                    2’ Type II                   3’


Unstable Tachycardia


 Still has a pulse, but not for long.



  • Wide or Narrow? Regular or Irregular?

  • Stable vs. Unstable: you’ll need to know the difference.

  • No drugs here folks, only electricity.  What type? How much?


Stable Tachycardia


Stable patient here.



  • Wide or Narrow? Regular or Irregular?

  • Know the treatment for

    • Regular Narrow:

    • Regular Wide:

    • Irregular Narrow:

    •  Irregular Wide:


Acute Stroke


Different Strokes for Different Folks.


  • Recognize physical presentation.

  • Establish onset of symptoms.

  • CT scan, possible fibrolytic therapy.


The megacode is your final test. At the end of the course we will test your ability to move from algorithm to algorithm. Please understand that the algorithm will change and that may not be because of your treatment.



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