Algorithms

The core ACLS loop: high-quality CPR, rhythm checks every 2 minutes, shocks for VF/pVT, and epinephrine early for non-shockable rhythms.

Decide unstable vs stable, then narrow vs wide QRS. Unstable patients get synchronized cardioversion; stable patients get vagal maneuvers, adenosine, or antiarrhythmics.

Treat bradycardia only when it causes symptoms. Atropine first; if ineffective, transcutaneous pacing or a chronotropic infusion.

Stabilize airway, ventilation, and blood pressure; get a 12-lead; decide on emergent cath; control temperature in patients who don't follow commands.

12-lead within 10 minutes, aspirin, then reperfusion: primary PCI within 90 minutes or fibrinolysis within 30 minutes for STEMI.

Establish last known well, check glucose, image within 20 minutes, and treat eligible patients with thrombolysis and/or thrombectomy.

Recognize arrest within 10 seconds, start compressions, and get the AED on the patient as fast as possible.

Mild obstruction: let them cough. Severe obstruction: cycles of 5 back blows and 5 abdominal thrusts. Unresponsive: CPR.

Same loop as adults with weight-based shocks and drugs. Pediatric arrest is usually respiratory, so ventilation matters.

In children, bradycardia is usually hypoxia. Oxygenate and ventilate first; start CPR if HR < 60 with poor perfusion.

Separate sinus tachycardia from SVT by history, rate, and variability. Compromised patients get synchronized cardioversion.

Arrest in kids is usually respiratory. Start CPR for HR < 60 with poor perfusion; 2 rescuers use 15:2.

Infants: 5 back blows + 5 chest thrusts (never abdominal thrusts). Children: 5 back blows + 5 abdominal thrusts.

Support breathing first. Naloxone restores drive but does not replace ventilation or CPR.

Ventilation is the single most important step in newborn resuscitation. Compressions only if HR stays < 60 after 30 s of effective PPV.

Standard ACLS plus left uterine displacement, early airway, IV above the diaphragm, and resuscitative hysterotomy if no ROSC within minutes.

Epinephrine IM into the thigh is first-line and time-critical. Antihistamines and steroids are adjuncts only.

Calcium protects the heart in minutes, insulin and albuterol shift potassium in 15–30 minutes, and only binders, diuretics, or dialysis remove it.

High-risk PE with shock or arrest needs reperfusion: systemic thrombolysis unless contraindicated, otherwise surgical or catheter therapy.

Handle gently, rewarm by severity, and continue resuscitation during rewarming; ECMO is the best rewarming tool in arrest.

Cultures, lactate, broad-spectrum antibiotics, 30 mL/kg for hypoperfusion, and norepinephrine to MAP ≥ 65, all within the first hour.

Sodium channel blockade widens the QRS and causes arrhythmias and hypotension. Sodium bicarbonate is the antidote.

Cardiovert the unstable patient. Rate-control the stable one, tailoring the drug to heart failure and never giving AV nodal blockers in pre-excited AF.

Drowning arrest is hypoxic, so breaths come first and compression-only CPR is not adequate.

A clinical diagnosis. Don't wait for an X-ray in a crashing patient: decompress, then place a chest tube.

Bradycardia and shock that won't respond to atropine. Layer calcium, high-dose insulin, glucagon, and vasopressors, then rescue therapies.