BLS / ACLS cheat sheet

Adult out-of-hospital Chain of Survival: recognition and activation, CPR, defibrillation, advanced resuscitation, post-arrest care, and recovery.

In-hospital Chain of Survival includes surveillance and prevention, recognition and activation, rapid response, advanced resuscitation, post-arrest care, and recovery.

Unresponsiveness with no normal breathing or only agonal gasps is suspected cardiac arrest; CPR begins immediately.

Breathing and pulse are checked simultaneously for no more than 10 seconds before starting CPR when absent.

For an unresponsive adult, activate EMS and send a second rescuer for an AED while CPR is started.

Stroke recognition uses BE-FAST: balance, eyes, face, arm, speech, and time.

Suspected ACS with chest pain, diaphoresis, or nausea requires EMS activation and a 12-lead ECG.

Agonal gasps are irregular gasping breaths and are not effective breathing.

Adult compression rate is 100 to 120/min with depth at least 5 cm but not more than 6 cm.

Child compression depth is at least one-third of the anteroposterior chest diameter, about 5 cm or 2 inches.

Infant compression depth is at least one-third of the anteroposterior chest diameter, about 4 cm or 1.5 inches.

Full chest recoil occurs after each compression; leaning on the chest between compressions reduces cardiac output.

Interruptions in compressions are kept under 10 seconds and compression fraction is targeted above 60%, ideally above 80%.

Adult single-rescuer and two-rescuer CPR use a 30:2 compression-to-ventilation ratio.

Child and infant single-rescuer CPR uses 30:2; two-rescuer CPR uses 15:2.

Compressors switch about every 2 minutes or sooner with fatigue.

Infant compression uses two fingers for a single rescuer or two-thumb encircling for two rescuers.

Adult rescue breathing with a pulse but no normal breathing: 1 breath every 6 seconds, or 10 breaths/min.

Infant and child rescue breathing with a pulse but no normal breathing: 1 breath every 2 to 3 seconds, or 20 to 30 breaths/min.

Each rescue breath is delivered over about 1 second and produces visible chest rise.

Excessive ventilation raises intrathoracic pressure, lowers venous return, and reduces cardiac output.

Two-rescuer bag-mask ventilation is preferred because one rescuer maintains the airway seal while the other squeezes the bag.

An oropharyngeal airway is used in an unresponsive patient without a gag reflex.

Suctioning is limited to less than 10 seconds because it can cause hypoxemia and bradycardia.

If a pulse is absent, rescue breathing is replaced by CPR with compressions.

The AED is turned on and its prompts are followed; pads are applied to bare, dry chest skin.

Adult AED pad placement: one pad on the right upper chest and one on the left lateral chest below the axilla.

All rescuers are cleared from patient contact before rhythm analysis and before shock delivery.

CPR resumes immediately after a shock rather than checking rhythm or pulse first.

Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.

Pediatric AED pads or an attenuator are used for children under 8 years or under 25 kg; adult pads are used if pediatric pads are unavailable.

Biphasic defibrillation uses the manufacturer’s recommended energy, commonly 120 to 200 J; monophasic defibrillation uses 360 J.

For a patient in water, move the patient to a dry area before applying AED pads.

AED pads are placed at least 8 cm away from an implanted cardioverter-defibrillator or pacemaker.

Ventricular fibrillation has chaotic irregular waveforms with no identifiable QRS complexes and no pulse.

Pulseless ventricular tachycardia has wide regular complexes without a pulse and is treated as a shockable rhythm.

Asystole is a flat line with no electrical activity; confirm lead placement and gain, and treat as nonshockable.

Pulseless electrical activity is organized electrical activity without a palpable pulse and is nonshockable.

Unstable tachycardia with a pulse and hypotension, ischemia, or altered mentation is treated with synchronized cardioversion.

Stable supraventricular tachycardia is treated with adenosine 6 mg rapid IV push, then 12 mg if needed.

Symptomatic bradycardia with poor perfusion is treated with atropine 1 mg IV every 3 to 5 minutes, maximum 3 mg.

Defibrillation is unsynchronized and is used for ventricular fibrillation or pulseless ventricular tachycardia.

Synchronized cardioversion is timed to the QRS complex and is used for unstable tachyarrhythmias with a pulse.

Adult cardiac arrest epinephrine dose is 1 mg IV or IO every 3 to 5 minutes.

Pediatric cardiac arrest epinephrine dose is 0.01 mg/kg IV or IO every 3 to 5 minutes, maximum 1 mg per dose.

Adult refractory VF or pulseless VT: amiodarone 300 mg IV bolus, then 150 mg.

Lidocaine is an alternative for VF or pulseless VT: 1 to 1.5 mg/kg initial dose, then 0.5 to 0.75 mg/kg.

Atropine for symptomatic bradycardia is 1 mg IV every 3 to 5 minutes, maximum total dose 3 mg.

Adenosine for stable SVT is 6 mg rapid IV push; a second dose of 12 mg is used if the first dose fails.

Intraosseous access is used when IV access cannot be established promptly; drugs and fluids can be given by the IO route.

Calcium and sodium bicarbonate are not routine drugs in cardiac arrest.

Closed-loop communication: the leader gives a clear order, the receiver repeats it, and completion is reported back.

A designated team leader assigns roles, monitors CPR quality, and adjusts the plan.

Call-outs share critical information aloud so all team members have the same mental model.

SBAR handoff communicates situation, background, assessment, and recommendation.

Post-event debriefing identifies effective actions, failures, and specific changes for future resuscitations.

Rapid response teams are activated for hospitalized patients with deteriorating vital signs or mentation.

Quality metrics include compression fraction, compression rate, compression depth, and ventilation rate.

Family presence during resuscitation is offered with a designated staff member assigned to support the family.

After return of spontaneous circulation, assess airway, breathing, and circulation and obtain a 12-lead ECG.

Oxygen is titrated to SpO2 92% to 98%; prolonged hyperoxia is avoided.

PaCO2 target is 35 to 45 mm Hg; severe hyperventilation and hypoventilation are avoided.

Comatose post-arrest patients receive targeted temperature management at 32 to 37.5 degrees Celsius, and fever is prevented.

Hypotension is treated with IV fluids and vasopressors; MAP target is at least 65 mm Hg.

Recurrent shockable rhythms after ROSC are treated with immediate defibrillation and CPR.

STEMI after cardiac arrest is an indication for emergency coronary angiography and PCI.

Neuroprognostication is not reliable earlier than 72 hours after return to normothermia.

A 12-lead ECG is obtained within 10 minutes of ED arrival for suspected ACS.

Aspirin 162 to 325 mg is chewed early unless allergy or true contraindication exists.

Nitroglycerin is avoided when systolic blood pressure is below 90 mm Hg or a phosphodiesterase-5 inhibitor was taken recently.

STEMI at a PCI center: door-to-balloon time goal is 90 minutes or less.

STEMI without PCI access: door-to-needle fibrinolysis goal is 30 minutes or less when no contraindication exists.

Troponin is obtained at presentation and serially, but it does not replace ECG for STEMI reperfusion decisions.

Cardiogenic shock signs include hypotension, cool extremities, and altered mentation.

Last known well time is documented immediately for suspected stroke.

Noncontrast head CT is obtained within 20 minutes of arrival for suspected stroke.

Last known well time determines thrombolysis and thrombectomy eligibility.

Intravenous thrombolysis is considered within 3 to 4.5 hours of last known well for eligible ischemic stroke patients.

Endovascular thrombectomy is considered up to 24 hours in selected patients with large-vessel occlusion.

Blood glucose is checked because hypoglycemia can mimic stroke.

Blood pressure must be below 185/110 mm Hg before IV thrombolysis and below 180/105 mm Hg after treatment.

The NIH Stroke Scale quantifies stroke severity and supports treatment decisions.

BE-FAST recognizes balance, eyes, face, arm, speech, and time.

Eligible stroke patients are not delayed for extensive testing before thrombolysis.