Peri-arrest Arrhythmia Management Algorithm
Note: This document provides a structured summary of the Peri-arrest Arrhythmia Management Algorithm for educational and reference purposes. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines.
Patient has a pulse but is unstable due to a bradycardia or tachycardia.
ABCs, vital signs, 12-lead ECG, IV access, focused history & physical exam, identify signs of instability (hypotension, altered mental status, shock, chest pain, heart failure).
Bradycardia: HR < 50 bpm. Tachycardia: HR > 150 bpm (usually).
Manage according to the Adult Bradycardia Algorithm (With Pulse).
Atropine 1 mg IV (repeat every 3-5 min, max 3 mg). If ineffective, Transcutaneous Pacing (TCP) or Dopamine infusion (2-20 mcg/kg/min) or Epinephrine infusion (2-10 mcg/min).
Manage according to the Adult Tachycardia Algorithm (With Pulse).
Immediate Synchronized Cardioversion. Prepare for cardioversion, sedation if possible. Energy levels vary by rhythm type.
Review H’s and T’s: Hypoxia, Hypovolemia, Hypothermia, Hypo-/Hyperkalemia, Hydrogen ion (acidosis), Tamponade, Toxins, Tension pneumothorax, Thrombosis (coronary/pulmonary).
Consult Cardiology, Critical Care, or other specialists as needed.
