Cardiac Arrest Rhythms, Pea, AsystoleAPPROACH

RESUSCITATION AND UNIVERSAL APPROACHES · 19 SECTIONS

⚲

515 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Unresponsive Patient Airway Obstruction And Stridor Acute Respiratory Distress With Impending Failure Peri-arrest Hypotension Post Resuscitation Care After Rosc Cardiac Arrest Rhythms, Pea, Asystole Cardiac Arrest Rhythms, Vf, Pulseless Vt Severe Agitation With Safety Risk Procedural Sedation

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx45

Arrest circumstances

›Event timeline

›Witnessed arrest

›Unwitnessed arrest

›Last known well time

›No flow time estimate

›Low flow time estimate

›Pre arrest status

›Prodromal symptoms

›Chest pain

›Dyspnea

›Palpitations

›Syncope

›Seizure like activity

›Baseline functional status

›Recent illness

›Immediate context

›Location

›Home

›Public

›In hospital

›Activity at collapse

›Rest

›Exertion

›Sleep

›Trauma mechanism

Resuscitation history

›Prehospital and ED interventions

›Bystander CPR

›First rhythm documented

›Defibrillation attempts

›Airway method

›Epinephrine timing

›Other medications

›ROSC episodes

›Rearrest episodes

›Downstream reversible cause clues

›Hypoxia risk

›Drowning

›Aspiration

›Severe asthma

›Thrombosis risk

›Chest pain before arrest

›Dyspnea before arrest

›Toxin risk

›Opioid exposure

›Overdose scene evidence

02Alarm Features/alarm19

Time critical triggers

›Immediate escalation triggers

›PEA on monitor

›Asystole on monitor

›ETCO2 persistently low despite high quality CPR

›Recurrent loss of pulse after ROSC

›Suspected tension pneumothorax

›Suspected massive PE

›Suspected STEMI equivalent after ROSC

›Poor prognosis features

›Unwitnessed arrest

›No bystander CPR

›Prolonged no flow time

›Persistent asystole

Vital sign danger thresholds

›Post ROSC danger thresholds

›SBP less than 90 mmHg

›MAP less than 65 mmHg

›SpO2 less than 92 percent

›ETCO2 abruptly falling

›Temperature greater than 37.7 C

03Medications/meds26

Home and recent medications

›Medication exposures

›Beta blockers

›Calcium channel blockers

›Digoxin

›Antiarrhythmics

›Insulin

›Anticoagulants

›Antiplatelets

›Opioids

›Benzodiazepines

In arrest medications

›ACLS medications

›Epinephrine IV IO

›1 mg every 3 to 5 minutes

›Flush after dose

›Timing

›As soon as feasible for nonshockable rhythm

›Continue every 3 to 5 minutes during CPR

›Sodium bicarbonate IV

›Hyperkalemia suspected

›TCA overdose suspected

›Calcium chloride IV

›Hyperkalemia suspected

›Calcium channel blocker overdose suspected

›Naloxone

›Opioid associated arrest suspected

›Local protocol dependent

04Diet/diet11

Recent intake and exposures

›Intake context

›Poor oral intake

›Vomiting

›Diarrhea

›Possible dehydration

›Possible malnutrition

Substance exposures

›Dietary and ingestion risks

›Alcohol exposure

›Energy drink exposure

›Stimulant exposure

›Toxic ingestion suspected

05Review of Systems/ros22

Pre arrest symptoms

›Cardiopulmonary

›Chest pain

›Dyspnea

›Cough

›Hemoptysis

›Orthopnea

›Neurologic

›Syncope

›Headache

›Focal neurologic symptoms

›Seizure like activity

›Infectious

›Fever

›Rigors

›Recent viral symptoms

Bleeding and thrombosis symptoms

›Hemorrhage and clot clues

›GI bleeding symptoms

›Heavy vaginal bleeding

›Melena

›Recent surgery

›Leg pain

›Leg swelling

06Collateral History and Family History/chafh13

Collateral source

›Source and reliability

›Bystander report

›Family report

›EMS report

›Facility report

›Medication list available

Family history

›Inherited and early disease

›Sudden cardiac death

›Early coronary disease

›Cardiomyopathy

›Channelopathy

›Long QT syndrome

›Brugada syndrome

07Risk Factors/rf20

Cardiac risk

›Coronary and electrical risk

›Known CAD

›Prior MI

›Heart failure

›Cardiomyopathy

›Valvular disease

›QT prolonging medications

PE and thrombosis risk

›VTE risk

›Recent surgery

›Immobilization

›Active cancer

›Prior VTE

›Pregnancy

›Estrogen therapy

Metabolic and toxin risk

›Metabolic and exposure risk

›CKD

›Dialysis

›Diabetes mellitus

›Toxin exposure

›Overdose risk

08Differential Diagnosis/ddx30

Life threatening

›H and T reversible causes

›Hypovolemia

›Hypoxia

›Hydrogen ion

›Severe acidosis

›Hypo hyperkalemia

›Hypothermia

›Tension pneumothorax

›Tamponade

›Toxins

›Thrombosis pulmonary

›Massive PE

›Thrombosis coronary

›Acute coronary occlusion

›Other can not miss causes

›Massive hemorrhage

›Intracranial hemorrhage

›Aortic catastrophe

›Airway obstruction

Common

›Frequent etiologies

›ACS related arrest

›Hypoxic arrest

›Sepsis related arrest

›Hyperkalemia related arrest

›Overdose related arrest

Less common

›Zebras

›Anaphylaxis

›Adrenal crisis

›Pulmonary hypertension crisis

›Severe pulmonary embolism mimic

09Past Medical History/pmh14

Cardiac history

›Cardiac comorbidities

›CAD

›Heart failure

›Cardiomyopathy

›Prior cardiac arrest

›ICD

›Pacemaker

Non cardiac history

›Systemic comorbidities

›CKD

›Diabetes mellitus

›COPD

›Asthma

›Cirrhosis

›Malignancy

10Physical Exam/exam28

Confirm arrest and rhythm integrity

›Arrest confirmation

›Unresponsiveness

›Apnea

›No palpable central pulse

›Rhythm check quality

›Leads attached

›Gain appropriate

›Artifact excluded

›PEA differentiation

›Organized electrical activity on monitor

›No pulse on exam

›Femoral pulse check during rhythm pause

Reversible cause focused exam

›Cause directed findings

›Airway

›Obstruction evidence

›Vomitus

›Breathing

›Unilateral breath sounds

›High airway pressure

›Circulation

›JVP elevation

›Muffled heart sounds

›External bleeding

›Skin

›Urticaria

›Track marks

›Temperature

›Hypothermia

11Lab Studies/labs27

Point of care

›Immediate actionable labs

›Glucose

›Treat if low

›Treat if very high with DKA HHS concern after ROSC

›VBG or ABG

›pH

›PaCO2 mmHg

›Lactate mmol/L

›Electrolytes

›Potassium mmol/L

›Ionized calcium mmol/L

›Sodium mmol/L

Post ROSC labs

›Etiology and organ injury labs

›CBC

›CMP

›Troponin

›Magnesium mmol/L

›Phosphate mmol/L

›Coagulation studies

›Type and screen

›Toxicology testing

›Acetaminophen level

›Salicylate level

›Ethanol level

›Limitations and timing

›Troponin may be elevated from arrest itself

›Lactate reflects global hypoperfusion

12Imaging/img37

Scoring Systems

›Decision tools

›No validated intra arrest scoring tool for PEA asystole decisions

›Termination decisions

›Local protocol dependent

›Incorporate no flow time

›Incorporate response to resuscitation

MRI

›Post ROSC neuro imaging

›Hypoxic ischemic injury assessment

›Timing typically delayed

›ICU pathway dependent

›Post ROSC CT use

›CT head

›Suspected intracranial hemorrhage

›Persistent coma after ROSC

›CT pulmonary angiography

›Suspected PE after ROSC

›Hemodynamic instability with supportive clues

›CT aorta

›Aortic catastrophe concern after ROSC

›Pulse deficit

›Contrast cautions

›CKD

›Anaphylactoid reaction risk

Ultrasound

›POCUS during arrest

›Cardiac views

›Pericardial effusion

›RV strain pattern

›Cardiac standstill

›Lung views

›Pneumothorax signs

›Bilateral B lines

›IVC assessment

›Marked collapse

›Marked plethoric pattern

›Pitfalls

›Minimize CPR pauses

›Interpret in clinical context

13Special Tests/spec20

Monitoring and procedural diagnostics

›Resuscitation monitoring

›Capnography

›ETCO2 confirmation of tube placement

›Sudden ETCO2 rise suggesting ROSC

›Arterial line

›CPR diastolic pressure monitoring when feasible

›Vasopressor titration after ROSC

›Temperature monitoring

›Hypothermia detection

›Fever avoidance after ROSC

Etiology directed tests

›Targeted diagnostics

›Pregnancy test

›Reproductive age

›Consider ectopic hemorrhage

›Point of care ultrasound guided pericardiocentesis

›Tamponade physiology

›Skilled operator required

›Bedside chest decompression confirmation

›Tension pneumothorax suspected

›Clinical response

14ECG/ecg21

Rhythm evaluation

›Arrest rhythm verification

›True asystole confirmation

›Lead change

›Gain increase

›Fine VF consideration

›Defibrillate if VF confirmed

›Avoid shocks for true asystole

›PEA characteristics

›Narrow complex PEA

›Wide complex PEA

Post ROSC 12 lead ECG

›Ischemia evaluation

›STEMI

›New LBBB pattern

›Posterior MI pattern

›Right ventricular infarct pattern

›Conduction and electrolyte clues

›Hyperkalemia patterns

›QRS widening

›Sine wave progression

›QT prolongation

›Torsades risk

15Assessment/ax21

Rhythm based diagnosis

›Nonshockable cardiac arrest

›Pulseless electrical activity

›Asystole

›Recurrent nonshockable rearrest

›Response to resuscitation

›ROSC achieved

›No ROSC

›Intermittent ROSC

Likely etiology synthesis

›Leading reversible causes

›Hypoxia

›Hypovolemia

›Hyperkalemia

›Massive PE

›Tamponade

›Tension pneumothorax

›Toxin mediated arrest

›Supporting features

›History clues

›POCUS clues

›Lab clues

›ECG clues

16Plan/plan124

First 5 minutes

›Immediate workflow

›High quality CPR

›Rate 100 to 120 per minute

›Depth 5 to 6 cm

›Full recoil

›Minimize pauses

›Switch compressor every 2 minutes

›Defibrillator monitor attachment

›Rhythm confirmation

›Artifact reduction

›Airway and oxygenation

›Bag mask ventilation with O2

›Airway adjuncts

›Avoid hyperventilation

›IV or IO access

›Large bore IV

›IO if IV delayed

›Epinephrine IV IO

›1 mg as soon as feasible

›Repeat every 3 to 5 minutes

›Reassessment loop every 2 minutes

›Rhythm check

›Pulse check

›CPR quality check

PEA asystole algorithm

›Core sequence

›CPR cycles

›2 minute cycles

›Rhythm checks under 10 seconds

›Epinephrine schedule

›Every 3 to 5 minutes

›Track timing visibly

›Advanced airway consideration

›Supraglottic airway

›Endotracheal intubation

›Capnography required

›Reversible causes treatment

›H and T checklist each cycle

›POCUS integrated with minimal pause

Reversible causes actions

›Hypoxia

›Ventilation optimization

›Confirm chest rise

›Correct obstruction

›Airway confirmation

›Capnography waveform

›Tube depth reassessment

›Hypovolemia

›Hemorrhage control

›Direct pressure

›Tourniquet if extremity source

›Volume resuscitation

›Crystalloid bolus after ROSC

›Blood products if hemorrhage suspected

›Hydrogen ion

›Severe acidosis support

›Adequate ventilation

›Bicarbonate for specific indications

›Hypo hyperkalemia

›Hyperkalemia treatment

›Calcium chloride IV

›Insulin with dextrose after ROSC

›Sodium bicarbonate IV for severe acidosis or hyperkalemia

›Hypokalemia treatment after ROSC

›Potassium replacement

›Magnesium replacement if low

›Hypothermia

›Rewarming

›Active external warming

›Warmed fluids

›Defibrillation and drugs

›Local protocol dependent modifications

›Tension pneumothorax

›Decompression

›Finger thoracostomy

›Needle decompression if finger thoracostomy not available

›Tube thoracostomy

›Ongoing air leak management

›Confirm reexpansion

›Tamponade

›POCUS confirmation

›Pericardial effusion

›RA RV diastolic collapse

›Pericardiocentesis

›Skilled operator

›Ultrasound guidance

›Toxins

›Opioid toxidrome

›Naloxone per protocol

›Ventilation priority

›TCA overdose

›Sodium bicarbonate IV

›QRS narrowing goal after ROSC

›Beta blocker overdose

›Glucagon per protocol

›High dose insulin therapy after ROSC

›Calcium channel blocker overdose

›Calcium chloride IV

›High dose insulin therapy after ROSC

›Thrombosis pulmonary

›Massive PE pathway

›POCUS RV strain pattern

›Thrombolysis consideration

›Local protocol dependent

›Mechanical thrombectomy

›Post ROSC consultation

›Center capability dependent

›Thrombosis coronary

›STEMI pathway after ROSC

›Immediate 12 lead ECG

›Cath lab activation criteria

›Local protocol dependent

›Coronary occlusion without STEMI

›Hemodynamic instability

›Refractory ventricular arrhythmias

Termination and ECPR considerations

›Advanced options

›ECPR candidacy screen

›Witnessed arrest

›Short no flow time

›Potentially reversible cause

›Center capability dependent

›Termination of resuscitation

›Persistent asystole despite optimized resuscitation

›No reversible cause identified

›Prolonged low flow time

›Local protocol dependent

17Disposition/dispo17

Level of care after ROSC

›ICU disposition criteria

›Any ROSC after cardiac arrest

›Need for vasoactive support

›Mechanical ventilation

›Targeted temperature management pathway dependent

›Ongoing arrhythmia risk

›Cath lab considerations

›STEMI on ECG

›High suspicion coronary occlusion with instability

›Transfer criteria

›ECPR capable center need

›PCI capable center need

›Neurocritical care need

No ROSC pathways

›Death determination and documentation

›Termination per local protocol

›Medical examiner criteria

›Organ donation referral per local process

18Discharge Instructions/di10

Copy discharge instructions

›Not typically applicable

›Cardiac arrest survivors rarely discharged from ED

›If discharge occurs after prolonged hospitalization

›Instructions follow inpatient care team plan

›Return to ED criteria

›Chest pain

›Dyspnea

›Syncope

›Palpitations

›New neurologic symptoms

19References/r10

Guidelines and key sources

›Core references

›American Heart Association Guidelines for CPR and ECC 2025

›American Heart Association Focused Update on Adult ACLS 2023

›American Heart Association Adult Cardiac Arrest Algorithm 2020

›European Resuscitation Council Guidelines 2021 Adult Advanced Life Support

›European Resuscitation Council Guidelines 2025 Adult Advanced Life Support

›ILCOR Consensus on Science with Treatment Recommendations

›Project instructions

›Evidence based clinical reference generator

›Formatting and structure rules

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Cardiac Arrest Rhythms, Pea, AsystoleAPPROACH

RESUSCITATION AND UNIVERSAL APPROACHES · 19 SECTIONS

⚲

515 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx45

Arrest circumstances

›Event timeline

›Witnessed arrest

›Unwitnessed arrest

›Last known well time

›No flow time estimate

›Low flow time estimate

›Pre arrest status

›Prodromal symptoms

›Chest pain

›Dyspnea

›Palpitations

›Syncope

›Seizure like activity

›Baseline functional status

›Recent illness

›Immediate context

›Location

›Home

›Public

›In hospital

›Activity at collapse

›Rest

›Exertion

›Sleep

›Trauma mechanism

Resuscitation history

›Prehospital and ED interventions

›Bystander CPR

›First rhythm documented

›Defibrillation attempts

›Airway method

›Epinephrine timing

›Other medications

›ROSC episodes

›Rearrest episodes

›Downstream reversible cause clues

›Hypoxia risk

›Drowning

›Aspiration

›Severe asthma

›Thrombosis risk

›Chest pain before arrest

›Dyspnea before arrest

›Toxin risk

›Opioid exposure

›Overdose scene evidence

02Alarm Features/alarm19

Time critical triggers

›Immediate escalation triggers

›PEA on monitor

›Asystole on monitor

›ETCO2 persistently low despite high quality CPR

›Recurrent loss of pulse after ROSC

›Suspected tension pneumothorax

›Suspected massive PE

›Suspected STEMI equivalent after ROSC

›Poor prognosis features

›Unwitnessed arrest

›No bystander CPR

›Prolonged no flow time

›Persistent asystole

Vital sign danger thresholds

›Post ROSC danger thresholds

›SBP less than 90 mmHg

›MAP less than 65 mmHg

›SpO2 less than 92 percent

›ETCO2 abruptly falling

›Temperature greater than 37.7 C

03Medications/meds26

Home and recent medications

›Medication exposures

›Beta blockers

›Calcium channel blockers

›Digoxin

›Antiarrhythmics

›Insulin

›Anticoagulants

›Antiplatelets

›Opioids

›Benzodiazepines

In arrest medications

›ACLS medications

›Epinephrine IV IO

›1 mg every 3 to 5 minutes

›Flush after dose

›Timing

›As soon as feasible for nonshockable rhythm

›Continue every 3 to 5 minutes during CPR

›Sodium bicarbonate IV

›Hyperkalemia suspected

›TCA overdose suspected

›Calcium chloride IV

›Hyperkalemia suspected

›Calcium channel blocker overdose suspected

›Naloxone

›Opioid associated arrest suspected

›Local protocol dependent

04Diet/diet11

Recent intake and exposures

›Intake context

›Poor oral intake

›Vomiting

›Diarrhea

›Possible dehydration

›Possible malnutrition

Substance exposures

›Dietary and ingestion risks

›Alcohol exposure

›Energy drink exposure

›Stimulant exposure

›Toxic ingestion suspected

05Review of Systems/ros22

Pre arrest symptoms

›Cardiopulmonary

›Chest pain

›Dyspnea

›Cough

›Hemoptysis

›Orthopnea

›Neurologic

›Syncope

›Headache

›Focal neurologic symptoms

›Seizure like activity

›Infectious

›Fever

›Rigors

›Recent viral symptoms

Bleeding and thrombosis symptoms

›Hemorrhage and clot clues

›GI bleeding symptoms

›Heavy vaginal bleeding

›Melena

›Recent surgery

›Leg pain

›Leg swelling

06Collateral History and Family History/chafh13

Collateral source

›Source and reliability

›Bystander report

›Family report

›EMS report

›Facility report

›Medication list available

Family history

›Inherited and early disease

›Sudden cardiac death

›Early coronary disease

›Cardiomyopathy

›Channelopathy

›Long QT syndrome

›Brugada syndrome

07Risk Factors/rf20

Cardiac risk

›Coronary and electrical risk

›Known CAD

›Prior MI

›Heart failure

›Cardiomyopathy

›Valvular disease

›QT prolonging medications

PE and thrombosis risk

›VTE risk

›Recent surgery

›Immobilization

›Active cancer

›Prior VTE

›Pregnancy

›Estrogen therapy

Metabolic and toxin risk

›Metabolic and exposure risk

›CKD

›Dialysis

›Diabetes mellitus

›Toxin exposure

›Overdose risk

08Differential Diagnosis/ddx30

Life threatening

›H and T reversible causes

›Hypovolemia

›Hypoxia

›Hydrogen ion

›Severe acidosis

›Hypo hyperkalemia

›Hypothermia

›Tension pneumothorax

›Tamponade

›Toxins

›Thrombosis pulmonary

›Massive PE

›Thrombosis coronary

›Acute coronary occlusion

›Other can not miss causes

›Massive hemorrhage

›Intracranial hemorrhage

›Aortic catastrophe

›Airway obstruction

Common

›Frequent etiologies

›ACS related arrest

›Hypoxic arrest

›Sepsis related arrest

›Hyperkalemia related arrest

›Overdose related arrest

Less common

›Zebras

›Anaphylaxis

›Adrenal crisis

›Pulmonary hypertension crisis

›Severe pulmonary embolism mimic

09Past Medical History/pmh14

Cardiac history

›Cardiac comorbidities

›CAD

›Heart failure

›Cardiomyopathy

›Prior cardiac arrest

›ICD

›Pacemaker

Non cardiac history

›Systemic comorbidities

›CKD

›Diabetes mellitus

›COPD

›Asthma

›Cirrhosis

›Malignancy

10Physical Exam/exam28

Confirm arrest and rhythm integrity

›Arrest confirmation

›Unresponsiveness

›Apnea

›No palpable central pulse

›Rhythm check quality

›Leads attached

›Gain appropriate

›Artifact excluded

›PEA differentiation

›Organized electrical activity on monitor

›No pulse on exam

›Femoral pulse check during rhythm pause

Reversible cause focused exam

›Cause directed findings

›Airway

›Obstruction evidence

›Vomitus

›Breathing

›Unilateral breath sounds

›High airway pressure

›Circulation

›JVP elevation

›Muffled heart sounds

›External bleeding

›Skin

›Urticaria

›Track marks

›Temperature

›Hypothermia

11Lab Studies/labs27

Point of care

›Immediate actionable labs

›Glucose

›Treat if low

›Treat if very high with DKA HHS concern after ROSC

›VBG or ABG

›pH

›PaCO2 mmHg

›Lactate mmol/L

›Electrolytes

›Potassium mmol/L

›Ionized calcium mmol/L

›Sodium mmol/L

Post ROSC labs

›Etiology and organ injury labs

›CBC

›CMP

›Troponin

›Magnesium mmol/L

›Phosphate mmol/L

›Coagulation studies

›Type and screen

›Toxicology testing

›Acetaminophen level

›Salicylate level

›Ethanol level

›Limitations and timing

›Troponin may be elevated from arrest itself

›Lactate reflects global hypoperfusion

12Imaging/img37

Scoring Systems

›Decision tools

›No validated intra arrest scoring tool for PEA asystole decisions

›Termination decisions

›Local protocol dependent

›Incorporate no flow time

›Incorporate response to resuscitation

MRI

›Post ROSC neuro imaging

›Hypoxic ischemic injury assessment

›Timing typically delayed

›ICU pathway dependent

›Post ROSC CT use

›CT head

›Suspected intracranial hemorrhage

›Persistent coma after ROSC

›CT pulmonary angiography

›Suspected PE after ROSC

›Hemodynamic instability with supportive clues

›CT aorta

›Aortic catastrophe concern after ROSC

›Pulse deficit

›Contrast cautions

›CKD

›Anaphylactoid reaction risk

Ultrasound

›POCUS during arrest

›Cardiac views

›Pericardial effusion

›RV strain pattern

›Cardiac standstill

›Lung views

›Pneumothorax signs

›Bilateral B lines

›IVC assessment

›Marked collapse

›Marked plethoric pattern

›Pitfalls

›Minimize CPR pauses

›Interpret in clinical context

13Special Tests/spec20

Monitoring and procedural diagnostics

›Resuscitation monitoring

›Capnography

›ETCO2 confirmation of tube placement

›Sudden ETCO2 rise suggesting ROSC

›Arterial line

›CPR diastolic pressure monitoring when feasible

›Vasopressor titration after ROSC

›Temperature monitoring

›Hypothermia detection

›Fever avoidance after ROSC

Etiology directed tests

›Targeted diagnostics

›Pregnancy test

›Reproductive age

›Consider ectopic hemorrhage

›Point of care ultrasound guided pericardiocentesis

›Tamponade physiology

›Skilled operator required

›Bedside chest decompression confirmation

›Tension pneumothorax suspected

›Clinical response

14ECG/ecg21

Rhythm evaluation

›Arrest rhythm verification

›True asystole confirmation

›Lead change

›Gain increase

›Fine VF consideration

›Defibrillate if VF confirmed

›Avoid shocks for true asystole

›PEA characteristics

›Narrow complex PEA

›Wide complex PEA

Post ROSC 12 lead ECG

›Ischemia evaluation

›STEMI

›New LBBB pattern

›Posterior MI pattern

›Right ventricular infarct pattern

›Conduction and electrolyte clues

›Hyperkalemia patterns

›QRS widening

›Sine wave progression

›QT prolongation

›Torsades risk

15Assessment/ax21

Rhythm based diagnosis

›Nonshockable cardiac arrest

›Pulseless electrical activity

›Asystole

›Recurrent nonshockable rearrest

›Response to resuscitation

›ROSC achieved

›No ROSC

›Intermittent ROSC

Likely etiology synthesis

›Leading reversible causes

›Hypoxia

›Hypovolemia

›Hyperkalemia

›Massive PE

›Tamponade

›Tension pneumothorax

›Toxin mediated arrest

›Supporting features

›History clues

›POCUS clues

›Lab clues

›ECG clues

16Plan/plan124

First 5 minutes

›Immediate workflow

›High quality CPR

›Rate 100 to 120 per minute

›Depth 5 to 6 cm

›Full recoil

›Minimize pauses

›Switch compressor every 2 minutes

›Defibrillator monitor attachment

›Rhythm confirmation

›Artifact reduction

›Airway and oxygenation

›Bag mask ventilation with O2

›Airway adjuncts

›Avoid hyperventilation

›IV or IO access

›Large bore IV

›IO if IV delayed

›Epinephrine IV IO

›1 mg as soon as feasible

›Repeat every 3 to 5 minutes

›Reassessment loop every 2 minutes

›Rhythm check

›Pulse check

›CPR quality check

PEA asystole algorithm

›Core sequence

›CPR cycles

›2 minute cycles

›Rhythm checks under 10 seconds

›Epinephrine schedule

›Every 3 to 5 minutes

›Track timing visibly

›Advanced airway consideration

›Supraglottic airway

›Endotracheal intubation

›Capnography required

›Reversible causes treatment

›H and T checklist each cycle

›POCUS integrated with minimal pause

Reversible causes actions

›Hypoxia

›Ventilation optimization

›Confirm chest rise

›Correct obstruction

›Airway confirmation

›Capnography waveform

›Tube depth reassessment

›Hypovolemia

›Hemorrhage control

›Direct pressure

›Tourniquet if extremity source

›Volume resuscitation

›Crystalloid bolus after ROSC

›Blood products if hemorrhage suspected

›Hydrogen ion

›Severe acidosis support

›Adequate ventilation

›Bicarbonate for specific indications

›Hypo hyperkalemia

›Hyperkalemia treatment

›Calcium chloride IV

›Insulin with dextrose after ROSC

›Sodium bicarbonate IV for severe acidosis or hyperkalemia

›Hypokalemia treatment after ROSC

›Potassium replacement

›Magnesium replacement if low

›Hypothermia

›Rewarming

›Active external warming

›Warmed fluids

›Defibrillation and drugs

›Local protocol dependent modifications

›Tension pneumothorax

›Decompression

›Finger thoracostomy

›Needle decompression if finger thoracostomy not available

›Tube thoracostomy

›Ongoing air leak management

›Confirm reexpansion

›Tamponade

›POCUS confirmation

›Pericardial effusion

›RA RV diastolic collapse

›Pericardiocentesis

›Skilled operator

›Ultrasound guidance

›Toxins

›Opioid toxidrome

›Naloxone per protocol

›Ventilation priority

›TCA overdose

›Sodium bicarbonate IV

›QRS narrowing goal after ROSC

›Beta blocker overdose

›Glucagon per protocol

›High dose insulin therapy after ROSC

›Calcium channel blocker overdose

›Calcium chloride IV

›High dose insulin therapy after ROSC

›Thrombosis pulmonary

›Massive PE pathway

›POCUS RV strain pattern

›Thrombolysis consideration

›Local protocol dependent

›Mechanical thrombectomy

›Post ROSC consultation

›Center capability dependent

›Thrombosis coronary

›STEMI pathway after ROSC

›Immediate 12 lead ECG

›Cath lab activation criteria

›Local protocol dependent

›Coronary occlusion without STEMI

›Hemodynamic instability

›Refractory ventricular arrhythmias

Termination and ECPR considerations

›Advanced options

›ECPR candidacy screen

›Witnessed arrest

›Short no flow time

›Potentially reversible cause

›Center capability dependent

›Termination of resuscitation

›Persistent asystole despite optimized resuscitation

›No reversible cause identified

›Prolonged low flow time

›Local protocol dependent

17Disposition/dispo17

Level of care after ROSC

›ICU disposition criteria

›Any ROSC after cardiac arrest

›Need for vasoactive support

›Mechanical ventilation

›Targeted temperature management pathway dependent

›Ongoing arrhythmia risk

›Cath lab considerations

›STEMI on ECG

›High suspicion coronary occlusion with instability

›Transfer criteria

›ECPR capable center need

›PCI capable center need

›Neurocritical care need

No ROSC pathways

›Death determination and documentation

›Termination per local protocol

›Medical examiner criteria

›Organ donation referral per local process

18Discharge Instructions/di10

Copy discharge instructions

›Not typically applicable

›Cardiac arrest survivors rarely discharged from ED

›If discharge occurs after prolonged hospitalization

›Instructions follow inpatient care team plan

›Return to ED criteria

›Chest pain

›Dyspnea

›Syncope

›Palpitations

›New neurologic symptoms

19References/r10

Guidelines and key sources

›Core references

›American Heart Association Guidelines for CPR and ECC 2025

›American Heart Association Focused Update on Adult ACLS 2023

›American Heart Association Adult Cardiac Arrest Algorithm 2020

›European Resuscitation Council Guidelines 2021 Adult Advanced Life Support

›European Resuscitation Council Guidelines 2025 Adult Advanced Life Support

›ILCOR Consensus on Science with Treatment Recommendations

›Project instructions

›Evidence based clinical reference generator

›Formatting and structure rules

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.