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ACLS Megacode:
Initial Assessment:
- Check for responsiveness, breathing, and pulse.
- If unresponsive, call for help and initiate CPR.
- Attach defibrillator pads and monitor.
CPR:
- Perform chest compressions at a rate of 100-120/min, allowing full chest recoil.
- Provide rescue breaths at a ratio of 30:2.
- Continue CPR until ROSC is achieved or until medical help arrives.
Defibrillation:
- If VF/VT is present, deliver a defibrillation shock of 360 joules biphasic or 360 joules monophasic.
- If unsuccessful, increase the energy level to 400 joules biphasic or 400 joules monophasic and repeat.
- Continue defibrillation attempts until ROSC is achieved or until medical help arrives.
Emergency Medications:
- Epinephrine: 1 mg IV/IO every 3-5 minutes.
- Vasopressin: 40 units IV/IO every 3-5 minutes (if refractory to epinephrine).
- Amiodarone: 300 mg IV/IO over 20 minutes (if refractory to defibrillation).
- Lidocaine: 1 mg/kg IV/IO (if refractory to defibrillation).
- Sodium bicarbonate: 1 mEq/kg IV/IO (if metabolic acidosis).
- Calcium chloride: 10 mg/kg IV/IO (if hyperkalemia or calcium channel blocker overdose).
Advanced Airway Management:
- Intubate the patient if CPR is ineffective or if the patient is unable to maintain a patent airway.
- Consider cricothyrotomy if intubation is unsuccessful.
Post-ROSC Care:
- Monitor vital signs closely.
- Provide supportive care, including oxygen therapy, fluid resuscitation, and antibiotics.
- Address any underlying medical conditions that may have contributed to the arrest.