Algorithms for the Primary ACLS Cases

Sample Algorithms for the Primary ACLS Cases

One of the crucial components of effective ACLS is a familiarity with the major algorithms for different patient and/or provider scenarios. As a free resource for our visitors, this page contains links to sample algorithms for the main AHA Advanced Cardiac Life Support cases.

Before proceeding, it is a good idea to view our terms

Respiratory Arrest

This case presents the recommended assessment, intervention, and management options for a patient in respiratory arrest. The patient is unresponsive and unconscious. Respirations are absent or inadequate to maintain effective oxygenation and ventilation. The patient has a pulse. Even though the patient is in respiratory arrest and not in cardiac arrest, the BLS Primary Survey and the ACLS Secondary Survey are used.

Go to algorithm: Basic Life Support (BLS) Primary Survey

Go to algorithm: ACLS Secondary Survey

Ventricular Fibrillation/Pulseless Vetricular Tachycardia Treated with CPR and AED

This case presents how to respond to someone who collapses outside of the hospital setting from either ventricular fibrillation (VF) or ventricular tachycardia (VT). You are alone and must manage the patient by yourself. You do not have the option of ACLS interventions, including advanced airway control and IV medications. You have an automated external defibrillator (AED) with a pocket face mask.

Go to algorithm: Managing VF and Pulseless VT Using BLS Healthcare Provider Algorithm

Ventricular Fibrillation and Pulseless Vetricular Tachycardia

This case focuses on the assessment and management of a patient in a witnessed cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The patient did not respond to the first shock. A manual defibrillator is used in this case, and you work with a care team.

Go to algorithm: Managing VF and Pulseless VT Using the Pulseless Arrest Algorithm

Pulseless Electrical Activity

Your task for this case is to assess and manage a patient in cardiac arrest who has pulseless electrical activity (PEA). Although the ECG shows organized cardiac electrical activity, the patient is unresponsive with no palpable pulse. Because finding and identifying an underlying cause is critical to patient outcome, the team searches for possible causes for PEA as they administer CPR.

Go to algorithm: Managing PEA with the ACLS Pulseless Arrest Algorithm

Asystole

The patient is in cardiac arrest, unresponsive with no pulse. The rhythm on the monitor is asystole (no discernible electrical activity on the ECG). For this case, you follow the ACLS Pulseless Arrest Algorithm for asystole. With other members of the emergency care team, you search for a treatable cause of asystole as you perform high quality CPR. IV/IO placement is a priority over advanced airway management. Interruptions to CPR are held to a minimum. The team discusses when to terminate resuscitation efforts and focus on supporting the patient's family.

Go to algorithm: Managing Asystole using the ACLS Pulseless Arrest Algorithm

Acute Coronary Syndromes

For this case, you use the Acute Coronary Syndromes Algorithm to guide the assessment and management of patients with signs and symptoms of acute coronary syndromes. A key focus of the case is the identification and treatment of ST-segment elevation myocardial infarction (STEMI). You use a 12-lead ECG to evaluate the patient's rhythm. You initiate treatment based on your assessment. Major components of the case include the following:

• Identification of acute ischemic chest pain
• Initial treatment of possible acute ischemic syndromes
• Emphasis on early reperfusion of the patient with STEMI

Go to algorithm: Managing the Patient Using the Acute Coronary Syndromes Algorithm

Bradycardia

This case outlines how to assess and manage a patient with symptomatic bradycardia. The patient has a pulse. One of your tasks is to figure out if the patient's signs and symptoms are caused by the slow heart rate or have an unrelated cause. Another task is to correctly diagnose the presence and type of atrioventricular (AV) block and implement the correct management strategies for AV blocks. You also need to know the techniques and cautions for using transcutaneous pacing.

Go to algorithm: Managing Bradycardia Using the ACLS Bradycardia Algorithm

Stable Tachycardia

This case presents the assessment and management of a stable patient with a pulse who has a heart rate greater than 100 bpm. Your tasks are to classify the tachycardia as narrow or wide, regular or irregular, and to implement the appropriate interventions from the ACLS Tachycardia Algorithm, including vagal maneuvers and adenosine. Monitor the patient's rhythm and request a cardiac consultation if the patient's rhythm does not convert. If the patient becomes unstable, follow the algorithm for unstable tachycardia.

Go to algorithm: Managing Stable Tachycardia Using the ACLS Tachycardia Algorithm

Unstable Tachycardia

Your first step in managing a patient with tachycardia is to determine if the patient has a pulse. If a pulse is present, your next steps are to decide if the patient's rhythm is stable or unstable and treat the patient appropriately, following the recommendations in the ACLS Tachycardia Algorithm. For unstable tachycardia, you evaluate the patient for cardioversion and perform the procedure. Drugs are not used to manage unstable tachycardia.

Go to algorithm: Managing Unstable Tachycardia using the ACLS Tachycardia Algorithm

Acute Stroke

This case presents the identification and initial management of patients with acute ischemic stroke, a sudden change in neurologic function brought on by a change in blood flow to the brain. This case is in scope for ACLS providers and covers fundamental out-of-hospital care, as well as basic aspects of initial in-hospital acute stroke care:

Out-of-hospital care

• Rapid identification and assessment of the patient
• Rapid transport and pre-arrival notification to a facility that can provide acute stroke care

In-hospital acute stroke care

• Ability to figure out quickly if patient is eligible for fibrinolytic therapy
• Administration of fibrinolytic therapy to patients that qualify
• Availability of neurologic medical supervision within NINDS target times
• Patient begins stroke pathway and is admitted to a stroke unit, if one is available

National Institute of Neurological Disorders and Stroke (NINDS) time goals are implemented.