EKG
Cardiac arrest rhythms & ACLS
EKG

Cardiac arrest rhythms & ACLS

Shockable vs non-shockable rhythms; the ACLS algorithm in plain English.

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◆Shockable rhythms

  • •Ventricular fibrillation (VFib): chaotic, no QRS
  • •Pulseless ventricular tachycardia (pulseless VT)
  • •→ DEFIBRILLATE (unsynchronized) ASAP; resume CPR immediately × 2 min

◆Non-shockable rhythms

  • •Asystole: flat line — confirm in 2 leads, check leads/gain
  • •PEA (pulseless electrical activity): organized rhythm on monitor but no pulse
  • •→ CPR + epinephrine 1 mg IV every 3–5 min; treat reversible causes

◆Reversible causes — the 'H's and T's

  • •Hs: hypovolemia, hypoxia, H+ (acidosis), hypo/hyperK, hypothermia
  • •Ts: tension PTX, tamponade, toxins, thrombosis (pulmonary or coronary)
  • •Each one has a specific fix: fluids, oxygen, bicarb, calcium/K shift, warming, needle decompression, pericardiocentesis, antidote, lytics/PCI

◆Post-ROSC care

  • •Targeted temperature management 32–36°C × 24 hr (for comatose post-arrest)
  • •Get 12-lead EKG to look for STEMI → emergency cath
  • •Hemodynamic support, mechanical ventilation, neuro prognostication ≥72 hr after rewarming

High-yield pearls

  • ◆Don't interrupt compressions for pulse checks longer than 10 seconds
  • ◆First-line for refractory VFib after 3 shocks: amiodarone 300 mg IV bolus
  • ◆End-tidal CO₂ < 10 mmHg during CPR after 20 minutes = poor prognosis (consider stopping)
  • ◆Eyewitnessed arrest of young athlete on field → suspect HCM, commotio cordis (blunt chest trauma during T-wave), congenital LQT
Rhythm strip
Ventricular fibrillation
Chaotic, no organized QRS — shock
Rhythm strip
Asystole
Flat line — confirm in 2 leads
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