Latest adult BLS and ACLS algorithms

1. Adult BLS for healthcare professionals

1. Ensure scene safety.
2. Check responsiveness, call for help, activate emergency response, and obtain an AED/defibrillator.
3. Assess breathing and pulse simultaneously for no more than 10 seconds.
4. If no normal breathing or only gasping and no definite pulse:
   • Start CPR: 30 compressions : 2 breaths
   • Compression rate: 100-120/min
   • Depth: at least 5 cm (2 in), avoiding >6 cm (2.4 in)
   • Full chest recoil, minimal interruptions, change compressor every 2 minutes.
   • Apply AED/defibrillator as soon as available.
5. If a pulse is present but breathing is absent or inadequate:
   • Give 1 breath every 6 seconds (10/min)
   • Reassess pulse every 2 minutes.
6. If opioid overdose is suspected, provide CPR/ventilation first; naloxone may be given if available but must not delay resuscitation or AED use.

2. Adult ACLS cardiac-arrest algorithm

A. Shockable rhythm: VF/pulseless VT

1. Shock.
2. Resume CPR for 2 minutes, establish IV/IO access.
3. Rhythm check: if still VF/pVT, shock again.
4. Resume CPR and give:
   • Epinephrine 1 mg IV/IO every 3-5 min
5. Rhythm check: if still VF/pVT, shock again.
6. Resume CPR and give one antiarrhythmic:
   • Amiodarone 300 mg IV/IO bolus, then 150 mg if needed, or
   • Lidocaine 1-1.5 mg/kg IV/IO, then 0.5-0.75 mg/kg if needed.
7. Continue cycles of CPR, rhythm checks, shocks, drugs, and reversible-cause management.

B. Non-shockable rhythm: PEA/asystole

1. Start CPR immediately.
2. Give epinephrine 1 mg IV/IO as soon as feasible, then every 3-5 minutes.
3. Recheck rhythm every 2 minutes.
4. If the rhythm becomes VF/pVT, switch to the shockable pathway.
5. Actively identify and treat reversible causes.

3. Reversible causes: Hs and Ts

• Hs: hypovolemia, hypoxia, hydrogen ion excess/acidosis, hypo/hyperkalemia and metabolic disorders, hypothermia.
• Ts: tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis.

4. If ROSC occurs

• Maintain oxygen saturation 90%-98%
• Avoid hyperoxia and hypotension
• Obtain 12-lead ECG
• Treat hypotension with fluids and/or vasopressors
• Consider coronary reperfusion for suspected acute coronary occlusion
• Control temperature and manage seizures when indicated
• Provide ICU-level care and investigate the cause of arrest

Important recent points

• In refractory VF/pVT after 3 or more shocks, the usefulness of routine double sequential external defibrillation has not been established. Vector-change defibrillation may be considered according to local protocol.
• Continuous high-quality CPR and early defibrillation remain the interventions with the strongest practical impact.
• These are adult algorithms. Pediatric BLS/PALS and neonatal resuscitation use different pathways and medication doses.