Cardiac Arrest — Adult ALS

3First steps

1. 1
   Start high-quality compressionsAction
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   Depth 5–6 cm, rate 100–120/min, full recoil, swap the compressor every two cycles.

2. 2
   Attach pads and analyze the rhythmDiagnostic
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   Shockable (VF/pVT)? Shock immediately, then resume compressions at once without a pulse check.

3. 3
   Ventilate without interrupting compressionsAction
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   Bag-valve-mask at 30:2, or one breath every 6 seconds once an advanced airway is in.

4. 4
   Adrenaline and antiarrhythmics on scheduleDrug
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   Adrenaline 1 mg IV every 3–5 min (immediately in non-shockable rhythms); amiodarone 300 mg after the third shock.

5. 5
   Hunt and treat a reversible causeAction
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   Run the 4H/4T out loud with the team every cycle — echo during rhythm checks helps.

6Differential diagnosis

• VF / pulseless VTImmediate

  Shockable — defibrillation is the absolute priority.

• AsystoleImmediate

  Confirm pads and leads before accepting it.

• PEAImmediate

  Hunt stubbornly for a reversible cause — often hypovolemia or obstruction.

8References

1. ERC Guidelines 2021 — Adult advanced life support (2021)Open source in new tab