CPR and ACLS Essentials
Based on the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care
Adult high-quality CPR
- Check responsiveness; shout for help; activate emergency response; get the AED.
- Check breathing and carotid pulse together for ≤10 sec.
- Compress the lower half of the sternum: 100–120/min, depth at least 2 in (5 cm) but not more than 2.4 in (6 cm), full chest recoil.
- 30:2 compressions to breaths without an advanced airway.
- With an advanced airway: continuous compressions + 1 breath every 6 sec.
- Minimize pauses (<10 sec); switch compressors every 2 min; avoid over-ventilation.
AED steps
- Turn it on and follow the prompts.
- Bare, dry chest; pads on (remove medication patches; place pads away from an implanted device).
- Stand clear while it analyzes.
- If shock advised: everyone clear, shock.
- Resume CPR immediately, starting with compressions. Don't stop to check a pulse after the shock.
Suspected opioid overdose: give naloxone, but CPR comes first if there's no pulse.
Cardiac arrest: the two pathways
Shockable: VF / pulseless VT
- Shock → CPR 2 min (get IV/IO access).
- Shock → CPR 2 min + epinephrine 1 mg every 3–5 min; consider advanced airway.
- Shock → CPR 2 min + amiodarone 300 mg (2nd dose 150 mg) or lidocaine; treat reversible causes.
Non-shockable: asystole / PEA
- CPR 2 min + epinephrine 1 mg as soon as possible, then every 3–5 min.
- Rhythm check every 2 min. If it becomes shockable, switch pathways.
- Search for and treat the Hs and Ts.
Defibrillation vs. cardioversion
| Defibrillation | Synchronized cardioversion | |
|---|---|---|
| For | Pulseless VF/VT; polymorphic VT | Unstable tachycardia with a pulse (A-fib, flutter, SVT, monomorphic VT) |
| Sync | Off | On: shock timed to the R wave so it doesn't land on the T wave |
| Patient | Unconscious | Often awake: sedate if possible; consent if time allows |
If the patient goes into VF during cardioversion: turn sync off and defibrillate.
Key ACLS drugs
| Epinephrine | 1 mg IV/IO every 3–5 min in arrest |
| Amiodarone | Arrest: 300 mg, then 150 mg. Stable VT with pulse: 150 mg over 10 min |
| Lidocaine | 1–1.5 mg/kg, then 0.5–0.75 mg/kg |
| Adenosine | 6 mg rapid push + flush, then 12 mg |
| Atropine | 1 mg every 3–5 min, max 3 mg (bradycardia) |
| Magnesium | 1–2 g IV (torsades) |
After ROSC
- Secure airway; SpO₂ 90–98%; PaCO₂ 35–45 (avoid hyperventilation).
- Avoid hypotension: MAP ≥65 mmHg.
- 12-lead EKG: STEMI → emergency cath.
- Not following commands: deliberate temperature control 32–37.5°C (89.6–99.5°F) for ≥36 h; prevent fever. Updated
- Check glucose; ongoing neuro assessment.
Safety during shocks
"I'm clear, you're clear, everyone's clear." Oxygen source away from the chest; nobody touching the patient or bed. Remove medication patches and wipe the skin. Place pads at least 1 in (2.5 cm) away from a pacemaker or ICD generator.