ACLS pointers Acute pulmonary edema,

hypotension, and shock algorithm

Follow these steps for treating three cardiopulmonary problems.
ASSESS THE PATIENT during the primary and secondary ABCD surveys to help determine the cause of acute pulmonary edema, hypotension, and shock. Initiate treatments based on the severity of the hypotension and the underlying cause.

Signs and symptoms: Shock, hypoperfusion, heart failure, acute pulmonary edema Most likely problem?

Acute pulmonary edema

Volume deficit problem

Pump problem

Furosemide, 0.5-1 mg/kg I.V. Morphine, 2-4 mg I.V. Sublingual nitroglycerin, 0.3 to 0.4 mg Oxygen and intubation as needed

Administer fluids, blood transfusions, and causespecific interventions. Consider vasopressors.

Blood pressure (BP)?

Systolic BP Systolic BP reading defines the second line of action (see below).

Systolic BP < 70 mm Hg and signs and symptoms of shock

Systolic BP = 70-100 mm Hg and signs and symptoms of shock

Norepinephrine,
mcg/min I.V.

0.5-30

Dopamine,

5-15 mcg/kg/min I.V.

Nitroglycerin or nitroprusside if systolic BP >100 mm Hg Dopamine if systolic BP = 70-100 mm Hg and patient Dobutamine
has signs and symptoms of shock if systolic BP >100 mm Hg and patient has no signs and symptoms of shock Further diagnostic and therapeutic considerations Pulmonary artery catheter Intra-aortic balloon pump Angiography for acute myocardial infarction or ischemia Additional diagnostic studies

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Rate problem

Bradycardia: Refer to the ACLS bradycardia algorithm.

Tachycardia: Refer to the ACLS tachycardia overview algorithm.

Systolic BP = 70-100 mm Hg and no signs and symptoms of shock

Systolic BP >100 mm Hg

Dobutamine,

2-20 mcg/kg/min I.V.

Nitroglycerin

I.V., 10-20 mcg/min I.V. Consider nitroprusside, 0.1-5 mcg/kg/min I.V.

Source: Mastering ACLS, Springhouse Corp., 2002.

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