AHA ACLS Provider cheat sheet

Normal sinus rhythm: rate 60-100/min, upright P wave in lead II before each QRS, PR 0.12-0.20 s, QRS <0.12 s.

Sinus bradycardia is <60/min; sinus tachycardia is >100/min with a sinus P-wave axis.

Atrial fibrillation: irregularly irregular, absent P waves, fibrillatory baseline; unstable patients receive synchronized cardioversion.

Regular narrow-complex tachycardia without visible P waves is typical AVNRT/AVRT; vagal maneuvers precede adenosine if stable.

Wide-complex tachycardia (QRS >=0.12 s) is treated as VT until proven otherwise, especially with structural heart disease.

VF is chaotic with no organized QRS; pulseless VT and VF are the two shockable arrest rhythms.

PEA is organized electrical activity without a palpable pulse; asystole is no electrical activity in more than one lead.

First-degree AV block: PR >0.20 s; Mobitz I: progressive PR prolongation; Mobitz II: constant PR with dropped QRS; third-degree: AV dissociation.

Torsades de pointes is polymorphic VT with a twisting axis around the baseline and is associated with prolonged QT.

Adult CPR: 100-120 compressions/min, depth 5-6 cm, full recoil, pauses <10 s.

Without an advanced airway: 30 compressions to 2 ventilations; with an advanced airway: 1 breath every 6 s (10/min) and continuous compressions.

Chest compression fraction target is >60%; rotate the compressor about every 2 minutes.

Defibrillation within 3-5 minutes of collapse raises survival; attach an AED as soon as it is available.

Bag-mask ventilation: 1 breath over 1 s, just enough volume for visible chest rise; avoid excessive rate or volume.

OPA is for unresponsive patients without a gag reflex; NPA is used when an OPA cannot be placed, with caution in facial trauma.

Confirm advanced airway placement with continuous waveform capnography plus clinical assessment.

During arrest use 100% oxygen; after ROSC titrate SpO2 to 92-98%.

VF/pVT: CPR, shock, CPR 2 min, rhythm check, shock; continue cycles.

Give epinephrine 1 mg IV/IO every 3-5 min after the second shock in VF/pVT; give it ASAP in PEA/asystole.

Give amiodarone 300 mg after the third shock, then 150 mg; lidocaine is an alternative.

Biphasic first shock 120-200 J (manufacturer range); monophasic 360 J; later shocks equal or higher.

PEA/asystole: CPR, epinephrine, and reversible-cause search; no shock.

Treat reversible Hs and Ts: hypoxia, hypovolemia, acidosis, K+ disorders, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis.

ETCO2 <10 mm Hg during CPR suggests inadequate compressions or no perfusion; abrupt rise suggests ROSC.

Do not interrupt compressions for rhythm checks longer than 10 s; check rhythm every 2 minutes.

Bradycardia with a pulse and instability: atropine 1 mg IV every 3-5 min, max 3 mg.

If atropine fails: transcutaneous pacing or dopamine 5-20 mcg/kg/min or epinephrine 2-10 mcg/min.

Stable narrow regular tachycardia: vagal maneuvers, then adenosine 6 mg, then 12 mg.

Unstable tachycardia with a pulse: synchronized cardioversion; pulseless or polymorphic VT: unsynchronized defibrillation.

Narrow irregular tachycardia usually is atrial fibrillation or flutter; unstable patients need synchronized cardioversion.

Wide regular tachycardia is treated as VT; adenosine may be considered only if regular and monomorphic and the patient is stable.

Torsades de pointes: magnesium 1-2 g IV and defibrillation if unstable.

Cardioversion energy: 50-100 J narrow regular, 120-200 J narrow irregular, 100 J wide regular (biphasic; follow device).

Epinephrine 1 mg IV/IO (1:10,000) every 3-5 min during arrest.

Amiodarone 300 mg IV bolus, then 150 mg for refractory VF/pVT.

Lidocaine 1-1.5 mg/kg IV, then 0.5-0.75 mg/kg every 5-10 min, max 3 mg/kg.

Adenosine 6 mg rapid IV push, then 12 mg; half-life <10 s.

Atropine 1 mg IV every 3-5 min, maximum 3 mg for symptomatic bradycardia.

Dopamine 5-20 mcg/kg/min; epinephrine infusion 2-10 mcg/min for bradycardia unresponsive to atropine.

Defibrillation is unsynchronized; synchronized cardioversion is used for perfusing tachyarrhythmias.

Routine sodium bicarbonate is not recommended in cardiac arrest; use only for specific indications such as hyperkalemia or tricyclic overdose.

ROSC is suggested by a palpable pulse, measurable blood pressure, and an abrupt sustained rise in ETCO2.

Post-ROSC: target SpO2 92-98%, PaCO2 35-45 mm Hg, and avoid hypotension (SBP <90 or MAP <65).

Obtain a 12-lead ECG and consider coronary angiography for STEMI or electrical instability.

Targeted temperature management and prevention of fever are part of post-arrest care; neuroprognostication is delayed.

Closed-loop communication: name the receiver, state the order, receive repeat-back, and confirm completion.

Team leader assigns roles, monitors CPR quality, and limits unnecessary interruptions.

Debrief after resuscitation to identify system and performance gaps.