Crisis Card

Code Blue / Adult ACLS

High-quality CPR. Reversible causes (Hs and Ts). Epi q3–5 min. Defibrillate shockable rhythms.

Call code, start CPR, rhythm check at 2 min

Recognize

Pulselessness or severe bradycardia with poor perfusion
Sudden loss of capnography trace
Asystole, PEA, VF, pulseless VT on monitor

Doses

Epinephrine

1 mg IV/IO q3–5 min

Amiodarone

300 mg IV (then 150 mg)

For shockable rhythms

Lidocaine

1–1.5 mg/kg IV (then 0.5–0.75)

Alternative antiarrhythmic

Defibrillation

200 J biphasic

Manufacturer max for monophasic

Bicarbonate

1 mEq/kg IV

Hyperkalemia, TCA OD, salicylate

Calcium chloride

1 g IV

Hyperkalemia, hypocalcemia, CCB OD

Sequenced Actions

1
Call code, start CPR
- Activate code blue / call for crash cart
- Rate 100–120/min, depth 2–2.4 inches, full recoil
- Minimize interruptions — switch compressors every 2 min
- Place defibrillator pads ASAP
2
Airway and ventilation
- Bag-mask with 100% O₂; advanced airway if not already intubated
- Once intubated: 10 breaths/min (asynchronous with compressions)
- Capnography to assess CPR quality (EtCO₂ > 10–20 desired)
3
Rhythm check every 2 min
- Shockable (VF / pulseless VT): defibrillate 200 J biphasic, immediate CPR
- Non-shockable (asystole / PEA): continue CPR, search for cause
- Pulse and rhythm check < 10 seconds
4
Epinephrine
- 1 mg IV/IO every 3–5 min
- Give as soon as possible in non-shockable; after 2nd shock in shockable
5
Antiarrhythmic for shockable rhythm
- Amiodarone 300 mg IV (then 150 mg if needed)
- Or lidocaine 1–1.5 mg/kg (then 0.5–0.75 mg/kg)
6
Search for reversible causes — Hs and Ts
Hs: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypothermia, Hypoglycemia Ts: Tension pneumothorax, Tamponade, Toxins, Thrombosis (PE), Thrombosis (MI), Trauma
7
Post-arrest care
- Targeted Temperature Management: 32–36 °C × 24 h (per latest evidence including TTM2, often 36 °C)
- Avoid fever × 72 h
- 12-lead EKG, troponin
- Cath lab if STEMI / shockable arrest
- ABG, lactate, glucose 140–180
- ICU disposition

Common Pitfalls

Hyperventilating after intubation — keep 10 breaths/min and watch capnography.
Long interruptions in compressions for pulse checks.
Forgetting to consider PE, tamponade, tension PTX — bedside US helps.
Skipping post-arrest TTM and cath when indicated.

References & Further Reading

1
GuidelineOpen source
Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for CPR and ECC. Circulation. 2020;142(16_suppl_2):S366-S468.
2
Journal
Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021;384(24):2283-2294.
3
Textbook
Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.
4
Textbook
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.

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