2005 Emergency Cardiovascular Care Guidelines Summary

The American Heart Association has released new guidelines for emergency cardiovascular care. A
summary of the performance changes in these guidelines are available for reference on this menu along the
left side of your screen. MosbyJems/Elsevier is currently developing updates to all affected products. The
revised editions will be available Fall 2006 for those who wish to incorporate the 2005 ECC Guidelines into
their programs.
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HCP BLS Infant Child Adult/Older Child

Age Less than 1 year 1 yr to about 12-14 years Puberty and older
A = Airway Open airway with head-tilt/chin-lift. If trauma is present, use jaw-thrust without head-tilt
maneuver. If unable to open airway using jaw-thrust, use head-tilt/chin-lift.
B = Breathing Look, listen, and feel. If breathing is adequate, place patient in recovery position. If
(assess up to 10 sec) breathing is inadequate or absent breathing, give 2 slow breaths.
Initial breaths 2 breaths, each breath lasting 1 sec

Rescue breathing without
compressions
If airway obstruction present:
Conscious victim
About 12-20 breaths/min
1 breath every 3-5 sec
5 back blows, then 5 chest
thrusts. Repeat until object
is expelled or patient
becomes unconscious
About 12-20 breaths/min About 10-12 breaths/min
1 breath every 3-5 sec 1 breath every 5-6 sec
Give abdominal thrusts until object is expelled or patient
becomes unconscious

Unconscious victim Try to ventilate. If no chest rise, reposition, try again. If no chest rise, begin CPR.

Finger sweeps No blind finger sweeps. Each time you open the airway to give breaths, look for the
object. Only use finger sweep to remove an object if you can visualize the object.
C = Circulation
(assess up to 10 sec)
Check pulse Brachial or femoral Carotid
Pulse present, support airway and breathing.
Chest landmarks
No pulse, start compressions, Call for AED.
Position fingers just below Center of chest between nipples
Compression depth
nipple line
1 rescuer: 2 fingers or 1 Hand: Heel of 1 hand or 2 Hands: Heel of 1 hand,
Compress chest with
2 rescuers: 2 thumbs as for adult depending on other hand on top
encircling chest size of child

About 1/3 to ½ depth of chest

Compression depth 1 ½ to 2 inches

Compression rate About 100/min

1 rescuer = 30:2 1 or 2 rescuers = 30:2

Compression/ventilation ratio 2 rescuers = 15:2 If an advanced airway is in
If an advanced airway is in place, do not pause to place, do not pause to
ventilate ventilate

D = Defibrillation,  Resuscitation guidelines  If witnessed arrest, use  If witnessed arrest, use

if necessary currently make no
recommendation for or
against AED use in
infants.
AED as soon as
available.
 If unwitnessed arrest,
use AED after 2 min of
CPR.
 Power on AED, apply
child pads/cable system.
Analyze rhythm, Follow
AED instructions; shock
if indicated.
AED as soon as
available.
 If unwitnessed arrest,
use AED after 5 cycles of
CPR, (2 min).
 Power on AED, apply
adult pads/cable system.
Analyze rhythm, Follow
AED instructions; shock
if indicated.

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Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier, Inc.
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ACLS 2005 Guidelines

CPR 1- or 2-rescuer compression-to-ventilation ratio 30:2
CPR before shock  EMS system medical directors may develop and use protocols in which EMS
personnel give about 5 cycles (about 2 min) of CPR before attempting
defibrillation when call-to-arrival interval is >4-5 min.
 Insufficient evidence to support or refute CPR before defibrillation for in-hospital
cardiac arrest
Positive-pressure  When using a bag-valve device (no advanced airway in place), deliver a tidal
ventilation with bag- volume sufficient to produce chest rise (about 6-7 mL/kg or 500-600 mL) over 1
mask device during sec. Emphasis is on producing visible chest rise.
CPR
 Give 2 breaths during a brief (about 3-4 sec) pause after every 30 chest
compressions.
Tracheal drug  Giving meds by the IV or IO route is preferred over tracheal administration.
administration  Lidocaine, epinephrine, atropine, naloxone, and vasopressin are absorbed via
the trachea.
 Optimal endotracheal dose of most drugs is unknown, typical endotracheal
dose is 2-2 1⁄2 times the IV dose.
Confirming tracheal  Using clinical assessment plus an exhaled CO2 detector or an esophageal
tube placement detector device to evaluate tube location is considered primary confirmation.
 Recheck advanced airway placement immediately after insertion, after securing
the tube, during transport, and whenever the patient is moved.
Symptomatic  Atropine 0.5 mg IV q 3-5 min, max dose 3 mg. If atropine ineffective, pacing.
bradycardia Consider epinephrine infusion (2-10 mcg/min) or dopamine infusion (2-10
mcg/kg/min) while awaiting a pacer or if pacing is ineffective. Prepare for
transvenous pacing. Treat contributing causes.
Use transcutaneous pacing without delay for high-grade (second-degree AV
block type II and third-degree AV block); atropine can be considered while
waiting for pacer.
Narrow-QRS  Tachycardia algorithms are now divided into narrow and wide-complex
tachycardia tachycardias, and regular and irregular tachycardias.
 Stable narrow-QRS tachycardia (excluding atrial fibrillation or atrial flutter)—
vagal maneuvers, adenosine; second-line drugs include a calcium channel
blocker (verapamil or diltiazem) or amiodarone (Circulation. 2005;112:III-34.)
Wide QRS  If the rhythm is believed to be SVT with aberrancy, adenosine 6 mg rapid IV
tachycardia bolus with 20 mL NS flush; repeat boluses can be given as for narrow-QRS
tachycardia
 If the rhythm is believed to be monomorphic VT, give amiodarone 150 mg IV
over 10 min. Repeat as needed to max dose of 2.2 g/24 hr
Unstable Synchronized cardioversion with 100J, 200J, 300J, 360J
monomorphic
ventricular
tachycardia (VT)
Atrial fib with rapid  Cardiac consult
ventricular response  Control rate with diltiazem, or beta-blockers.

Polymorphic VT  Amiodarone may be effective for stable polymorphic VT

 If prolonged QT interval (torsades de pointes), stop all drugs known to prolong
the QT interval. Correct electrolyte abnormalities, especially hypokalemia. Give
magnesium sulfate, 1-2 g IV mixed in 50-100 mL of D5W over 5-60 min Obtain
cardiac consult.
Pulseless VT/VF  Pattern is CPR–RHYTHM CHECK–CPR (while drug given and defibrillator
charged)–SHOCK
 If a prehospital healthcare provider does not witness the arrest, the provider

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ACLS 2005 Guidelines
may give 5 cycles of CPR before attempting defibrillation. If arrest is witnessed,
defibrillation is the priority.
 Stacked shock sequences eliminated.
 Optimal energy level for defibrillation using monophasic or biphasic waveforms
has not been determined. Follow manufacturer’s recommendation
 If VF is initially terminated by a shock but recurs later in the arrest, shock at the
last successful energy level.
 Procainamide and sodium bicarbonate deleted from algorithm
 Magnesium sulfate used only if rhythm is torsades
 Vasopressin may be used in place of first or second dose of epinephrine
 Do not interrupt CPR to give medications
 Pulse check only if organized rhythm seen on monitor
 No recommendation for or against precordial thump in pulseless VT/VF
 Insufficient evidence to recommend routine administration of fluids to treat
cardiac arrest
Asystole/PEA  Insufficient evidence to recommend for or against vasopressin use in PEA
 Pacing is not recommended in asystole.
Medical Emergency  Consider use of a MET (usually a physician and nurse with critical care training)
Team (MET) for adult hospital in-patients and early warning scoring (EWS) systems to
identify patients who may be critically ill or at risk of cardiac arrest.
Hypothermia “Unconscious adult patients with spontaneous circulation after out-of-hospital
postresuscitation cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial
rhythm was VF. Cooling to 32°C to 34°C for 12 to 24 hours may be considered for
unconscious adult patients with spontaneous circulation after out-of-hospital
cardiac arrest from any other rhythm or cardiac arrest in hospital.” (Circulation.
2005;112:III-37)

Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier, Inc.