Cardiac
ACLS Cardiac Algorithm Prioritization
Sequencing pacing, defibrillation, medications, and supportive care for bradycardia, tachycardia, and arrest rhythms.
Unstable versus stable pathways
Unstable patients with chest pain, hypotension, altered mental status, or acute heart failure need immediate rhythm-specific intervention—synchronized cardioversion for unstable tachycardia with pulses, transcutaneous pacing for unstable bradycardia, or defibrillation for pulseless VT/VF. Stable patients may receive medications and monitoring while preparing transport.
Cardiac arrest care prioritizes high-quality CPR and early defibrillation for shockable rhythms.1 Epinephrine every 3–5 minutes and amiodarone or lidocaine for refractory VF/VT follow ACLS sequencing—compressions pause only for rhythm checks and shocks. Capnography confirms airway placement and tracks perfusion during resuscitation.
Ranking interventions on exam items
The CDC emphasizes that cardiac arrest is sudden and often fatal without immediate action—algorithm drills train order discipline under stress.2 For symptomatic bradycardia: atropine when appropriate, then pacing if perfusion remains inadequate. For stable narrow-complex tachycardia, vagal maneuvers and adenosine precede beta-blockers or calcium channel blockers per protocol.
Post-ROSC care includes blood pressure support, 12-lead ECG, targeted temperature management per medical direction, and transport to capable facility. Rank items that restore perfusion before those that merely improve numbers—pacing before repeat atropine when HR stays 30 with altered mental status.
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