Comprehensive Algorithm for Pulselessness (Flowchart)
Comprehensive Algorithm for Pulselessness (Flowchart)
«Flowchart»

Person collapses
Possible cardiac arrest
Assess responsiveness

Person collapses
Possible cardiac arrest
Assess responsiveness

Person collapses
Possible cardiac arrest
Assess responsiveness

Person collapses
Possible cardiac arrest
Assess responsiveness Person collapses
Possible cardiac arrest
Assess responsiveness

Unresponsive

Unresponsive

Unresponsive

Unresponsive

Begin Primary ABCD Survey
(Begin BLS Algorithm)
Activate emergency response
Call for defibrillator
A Assess breathing (open airway, look, listen, and feel)

Begin Primary ABCD Survey
(Begin BLS Algorithm)
Activate emergency response
Call for defibrillator
A Assess breathing (open airway, look, listen, and feel)

Begin Primary ABCD Survey
(Begin BLS Algorithm)
Activate emergency response
Call for defibrillator
A Assess breathing (open airway, look, listen, and feel)

Begin Primary ABCD Survey
Begin BLS Algorithm)


A look, listen, and feel look, listen, and feel

Not breathing
B Give 2 slow breaths
C Assess pulse; if no pulse, then
C Start chest compressions
D Attach monitor/defibrillator when available

Not breathing
B Give 2 slow breaths
C Assess pulse; if no pulse, then
C Start chest compressions
D Attach monitor/defibrillator when available

Not breathing
B Give 2 slow breaths
C Assess pulse; if no pulse, then
C Start chest compressions
D Attach monitor/defibrillator when available

Not breathing
B
C
C
D

No pulse
CPR continues
Assess rhythm

No pulse
CPR continues
Assess rhythm

No pulse
CPR continues
Assess rhythm

No pulse

Secondary ABCD Survey

Airway: attempt to place airway device
Breathing: confirm and secure airway device, ventilations, oxygenation
Circulation: gain intravenous access; give adrenergic agent; consider antiarrhythmics, buffer agents, pacing
Non-VF/VT patients:
Epinephrine: 1 mg IV, repeat every 3-5 min
VF/VT patients:
Vasopressin: 40U IV single dose, 1 time only; or
Epinephrine: 1 mg IV, repeat dose every 3-5 min (if no response 10 min after single dose of vasopressin, may start epinephrine, 1 mg IV push; repeat every 3-5 min)
Differential Diagnosis: search for and treat reversible causes

Secondary ABCD Survey

Airway: attempt to place airway device
Breathing: confirm and secure airway device, ventilations, oxygenation
Circulation: gain intravenous access; give adrenergic agent; consider antiarrhythmics, buffer agents, pacing
Non-VF/VT patients:
Epinephrine: 1 mg IV, repeat every 3-5 min
VF/VT patients:
Vasopressin: 40U IV single dose, 1 time only; or
Epinephrine: 1 mg IV, repeat dose every 3-5 min (if no response 10 min after single dose of vasopressin, may start epinephrine, 1 mg IV push; repeat every 3-5 min)
Differential Diagnosis: search for and treat reversible causes

Secondary ABCD Survey

Airway: attempt to place airway device
Breathing: confirm and secure airway device, ventilations, oxygenation
Circulation: gain intravenous access; give adrenergic agent; consider antiarrhythmics, buffer agents, pacing
Non-VF/VT patients:
Epinephrine: 1 mg IV, repeat every 3-5 min
VF/VT patients:
Vasopressin: 40U IV single dose, 1 time only; or
Epinephrine: 1 mg IV, repeat dose every 3-5 min (if no response 10 min after single dose of vasopressin, may start epinephrine, 1 mg IV push; repeat every 3-5 min)
Differential Diagnosis: search for and treat reversible causes

Secondary ABCD Survey

Airway: attempt to place airway device Airway:
Breathing: confirm and secure airway device, ventilations, oxygenation Breathing:
Circulation: gain intravenous access; give adrenergic agent; consider antiarrhythmics, buffer agents, pacing
Non-VF/VT patients:
Epinephrine: 1 mg IV, repeat every 3-5 min
VF/VT patients:
Vasopressin: 40U IV single dose, 1 time only; or
Epinephrine: 1 mg IV, repeat dose every 3-5 min (if no response 10 min after single dose of vasopressin, may start epinephrine, 1 mg IV push; repeat every 3-5 min) Circulation:
Non-VF/VT patients:
Epinephrine:
VF/VT patients:
Vasopressin: or or or
Epinephrine: vasopressin epinephrine,
Differential Diagnosis: search for and treat reversible causes Differential Diagnosis:

VF/VT
Attempt defibrillation
(up to 3 shocks if VF persists)

VF/VT
Attempt defibrillation
(up to 3 shocks if VF persists)

VF/VT

VF/VT

Non-VF/VT
(Asystole or PEA)

Non-VF/VT
(Asystole or PEA)

Non-VF/VT
Non-VF/VT

CPR for 1 min

CPR for 1 min

CPR for 1 min CPR for 1 min CPR for 1 min

CPR for up to 3 min

CPR for up to 3 min

CPR for up to 3 min CPR for up to 3 min CPR for up to 3 min

CPR for 1 min

CPR for 1 min

CPR for 1 min

CPR for 1 min CPR for 1 min

CPR for up to 3 min

CPR for up to 3 min

CPR for up to 3 min

CPR for up to 3 min CPR for up to 3 min