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Universal Algorithm for Adult Emergency Cardiac Care

and Primary Survey ABCDs (Excerpt)
Assess responsiveness by speaking loudly, or gently shaking the patient if there
are no signs of trauma.
Call for help/crash cart if the patient is unresponsive.
A Airway: Open airway, look, listen, and feel for breathing.
B Breathing: If not breathing, slowly give 2 rescue breaths.
C Circulation: Check pulse. If pulseless, begin chest compressions at 100/min
(15:2 ratio with unprotected airway). Consider precordial thump in witnessed
arrest with no defibrillator immediately available.
D Defibrillation: Attach monitor/AED. Assess rhythm. Search for and Shock VF/PVT
up to 3 times if needed.
Secondary Survey ABCDs (Excerpt)
A Airway: Establish and secure an airway device.
B Breathing: Ventilate with 100% O2. Confirm airway device placement by exam, end-
tidal CO2 monitor, and O2 saturation monitor.
C Circulation: Evaluate rhythm, check pulse, if pulseless continue chest
compressions (5:1 ratio with protected airway), obtain IV access, give rhythm-
appropriate medications.
D Differential Diagnosis: Attempt to identify and treat reversible causes.
Asystole Algorithm
Asystole may be discovered during the primary ABCD survey after attaching a
monitor, or it may develop in a previously monitored patient. In either case, it
is essential that asystole be confirmed in another lead with properly functioning
equipment. If the patient is in true asystole and is a candidate for
resuscitation, then proceed with the secondary ABCD survey.
Interventions for asystole are guided by the instructive phrase and acronym,
“Asystole ….. Check me in another lead,
then let’s have a cup of TEA.”
Acronym – Intervention – Comments/Dose
T Transcutaneous Pacing (TCP) Only effective with early implementation
along with appropriate interventions and medications.
NOTE: Not effective with prolonged down time.
E Epinephrine 1 mg IV q3-5 min.
A Atropine 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)
Consider termination of efforts if asystole persists despite appropriate
Bradycardia Algorithm
Treatments for absolute bradycardia (
“All Trained Dogs Eat Iams”
NOTE:(The sequence reflects interventions for increasingly severe bradycardia)
Mnemonic – Intervention – Comments/Dose
All – Atropine – 0.5-1.0 mg IV push q 3-5 min. (max. dose 0.03-0.04 mg/kg)
Trained - TCP – Use Transcutaneous Pacing (TCP) immediately with severely
symptomatic patients.
Dogs - Dopamine 5-20 µg/kg/min.
Eat – Epinephrine 2-10 µg/min.
Iams – Isoproterenol 2-10 µg/min.
PEA Algorithm
Pulseless Electrical Activity may be discovered during the primary ABCD survey
when a monitor is attached to a pulseless patient and a rhythm is shown. As part
of the secondary ABCD survey, a doppler should be used to confirm pulselessness.
Interventions for pulseless electrical activity are guided by the letters
Intervention – Comments/Dose
Problem – Search for the probable cause and intervene accordingly. (see PEA
Problem Table )
[Pulmonary Embolism] – No pulse w/ CPR, JVD – Thrombolytics, surgery
[Acidosis] – (preexisting) Diabetic/renal patient, ABGs -Sodium bicarbonate,
[Tension pneumothorax] – No pulse w/ CPR, JVD, tracheal deviation – Needle
[Cardaic Tamponade] – No pulse w/ CPR, JVD, narrow pulse pressure prior to arrest
– Pericardiocentesis
[Hyperkalemia] – (preexisting) Renal patient, EKG, serum K level – Sodium
bicarbonate, calcium chloride, albuterol nebulizer, insulin/glucose, dialysis,
diuresis, kayexalate
[Hypothermia] – Core temperature – Hypothermia Algorithm
[Hypovolemia] – Collapsed vasculature – Fluids
[Hypoxia] – Airway, cyanosis, ABGs – Oxygen, ventilation
[Massive MI] – History, EKG – Acute Coronary Syndrome algorithm
[Drug Overdose] – Medications, illicit drug use – Treat accordingly
Epinephrine – 1 mg IV q3-5 min.
Atropine – With slow heart rate, 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)