ACLS

Shockable Rhythms

Non-shockable rhythms

Littman Approach: Narrow (<0.12) vs Wide (0.12+) QRS

Narrow: mechanical problems (RV inflow or outflow) Wide = metabolic, ischemic, or left ventricle

Specific reversals: from https://litfl.com/pulseless-electrical-activity/

• Hypovolemia – fluid, blood products, stop bleeding, clamp vessels
• Hypoxia – intubation and ventilation (FiO2 1.0)
• Hypokalemia – K+ replacement
• Hyperkalemia – treat cause, Ca2+ gluconate 10mL 10%, insulin-dextrose, salbutamol, NaHCO3
• Metabolic disorders – Mg2+ if low, Ca2+ if low, consider bicarbonate for acidaemia (e.g. with normal anion gap)
• Hyperthermia – cool, dantrolene for malignant hyperthermia
• Hypothermia– warm
• Toxicity – stop absorption, increase elimination, antidote to specific drug
• Tension pneumothorax – decompress (needle or finger thoracostomy prior to intercostal catheter)
• Tamponade – pericardiocentesis, open chest
• Thromboembolism – thrombolysis (proven or suspected pulmonary embolus) +/- surgical embolectomy