🦴
IO Access — Site
Select site in guideline order. Side logged with entry.
✏️
Edit ?
This will update patient details during the active resuscitation
👶
Edit
✅
Confirm ROSC?
Return of spontaneous circulation — this will stop all timers
🫁
Confirm Airway Change
Switching airway device — confirm placement and ventilation
🛑
Terminate Code?
All resuscitation efforts to be ceased — this will stop all timers
⏱️
30 Minutes Elapsed
Resuscitation has been ongoing for 30 minutes. Do you wish to continue or consider termination?
⚠️
End Code Blue?
Select outcome or cancel to continue
🏥
Patient Details
Optional — will appear on exported PDF
Patient Name
Patient ID / MRN
Location
Hospital
👥
Team Members
Optional — included in PDF export
👨‍⚕️
Team Leader
📋
Recorder
🫀
Compressor
🫁
Airway
➕
Others
📦
Export All as ZIP
↺
Reset Code Blue?
All timers, logs and drug counts will be cleared. This cannot be undone.
📄
Export Before Reset?
Would you like to save the event log and summary as a PDF before clearing?
💡 Patient name, ID & location can be entered on the next screen — required for medical records.
🫀
ROSC Achieved
Would you like to proceed to the post-ROSC checklist?
Bradyarrhythmia Algorithm
Step
1 of 3
Identify & Treat Underlying Cause · AHA 2025
Initial Assessment — ABCDE
A: Airway patent?
B: Assess breathing — Rate, Depth, Pattern, SpO₂
Administer O₂ if hypoxaemic (SpO₂ <94%)
Assist breathing with positive pressure ventilation if inadequate
C: Cardiac monitor — HR, Rhythm, BP, ECG
D: Drugs — Obtain IV access
E: 12-lead ECG — don't delay treatment
Consider Underlying Causes
Myocardial ischaemia / infarction
Drugs / toxicologic — CCB, beta-blockers, digoxin
Hypoxia
Electrolyte abnormality — e.g. hyperkalaemia
Bradyarrhythmia Algorithm
Step
2 of 3
Persistent Bradyarrhythmia · AHA 2025
Is the persistent bradyarrhythmia causing any of the following?
Hypotension
Acutely altered mental status
Signs of shock
Ischaemic chest discomfort
Acute heart failure
👁
Monitor and Observe
No adverse signs — continue monitoring.
Reassess if clinical status changes.
Bradyarrhythmia Algorithm
Step
3 of 3
Treatment — Symptomatic Bradycardia · AHA 2025
First Line
Atropine IV
First dose 1 mg IV bolus
Repeat Every 3–5 minutes
Maximum 3 mg total
If Atropine Ineffective
Transcutaneous Pacing
Preferred if atropine fails — initiate without delay
and / or
Dopamine IV infusion
5–20 mcg/kg/min · titrate to response · taper slowly
or
Epinephrine IV infusion
2–10 mcg/min · titrate to response
Consider
Expert consultation · Transvenous pacing
Tachyarrhythmia — Paediatric
Step
1 of 3
Initial Assessment & Support · PALS 2025
Child with suspected tachyarrhythmia
A — Airway
Maintain patent airway
B — Breathing
Assist breathing with positive-pressure ventilation and oxygen as necessary
Attach pulse oximetry · Check SpO₂
C — Circulation
Attach cardiorespiratory monitor
IV / IO access
12-lead ECG if available
Tachyarrhythmia — Paediatric
Step
2 of 3
Evaluate Rhythm · PALS 2025
Is this probable sinus tachycardia?
ECG Characteristics of Sinus Tachycardia
Heart rate Beat-to-beat variability with changes in activity or stress · <220/min infants · <180/min children
P waves Present and normal
PR interval Constant · normal duration
RR interval Variable
QRS complex Narrow — ≤0.09 sec
Sinus Tachycardia
Search & Treat Cause · PALS 2025
No antiarrhythmics needed — identify and treat the underlying cause
Common Causes
Exercise
Pain
Anxiety
Tissue hypoxia
Shock
Fever
Metabolic stress
Injury
Anaemia
Toxins / Drugs
Hypovolaemia — haemorrhagic and non-haemorrhagic fluid loss
Less Common Causes
Cardiac tamponade
Tension pneumothorax
Thromboembolism
Tachyarrhythmia — Paediatric
Step
2 of 3
Cardiopulmonary Compromise? · PALS 2025
Cardiopulmonary compromise?
Acutely altered mental status
Signs of shock
Hypotension
Tachyarrhythmia — Paediatric
Unstable
Evaluate QRS duration · PALS 2025
QRS duration?
Unstable — Narrow QRS
Unstable ≤0.09 sec
Probable SVT · PALS 2025
Probable SVT — ECG Features
Heart rate Infant ≥220/min · Child ≥180/min
P waves Absent or abnormal
RR interval Not variable
History Abrupt rate change
If IV/IO access present — Adenosine
1ST DOSE
0.1 mg/kg
Max 6 mg · rapid push + flush
2ND DOSE
0.2 mg/kg
Max 12 mg · if 1st ineffective
Dose calc
🔢
If IV/IO not available or adenosine ineffective
→ Synchronised Cardioversion
1st shock 0.5–1 J/kg
If ineffective 2 J/kg
Synchronise the defibrillator
Sedate if needed — do not delay cardioversion
Unstable — Wide QRS
Unstable >0.09 sec
Possible VT · PALS 2025
⚡ Confirm Pulse Present
No pulse Pulseless VT · Go to Cardiac Arrest Algorithm
Synchronised Cardioversion
1st shock 0.5–1 J/kg
If ineffective 2 J/kg
Synchronise the defibrillator
Sedate if needed — do not delay cardioversion
Expert Consultation
Advised before additional drug therapies
If Polymorphic VT
Unsynchronised shock — do not synchronise (unreliable on chaotic baseline)
If Torsades de Pointes — MgSO₄ 25–50 mg/kg IV over 10–20 min (max 2 g)
Treat cause — QT prolongation · electrolyte abnormality · drug toxicity
Tachyarrhythmia — Paediatric
Stable
Evaluate QRS duration · PALS 2025
QRS duration?
Stable — Narrow QRS
Stable ≤0.09 sec
Probable SVT · PALS 2025
Probable SVT — ECG Features
Heart rate Infant ≥220/min · Child ≥180/min
P waves Absent or abnormal
RR interval Not variable
History Abrupt rate change
If Probable SVT
1. Consider Vagal Manoeuvres
Ice to face — infants (15–30 sec)
Valsalva — older children
Do NOT apply ocular pressure
2. Give IV/IO Adenosine
1ST DOSE
0.1 mg/kg
Max 6 mg · rapid push + flush
2ND DOSE
0.2 mg/kg
Max 12 mg · if 1st ineffective
Dose calc
🔢
If above ineffective — Last option · Seek expert first
Amiodarone IV/IO
5 mg/kg over 20–60 min
Dose calc
🔢
or
Procainamide IV/IO
15 mg/kg over 30–60 min
Dose calc
🔢
Stable — Wide QRS
Stable >0.09 sec
Possible VT · PALS 2025
⚡ Check Pulse First
Pulse present Wide QRS tachycardia — manage as below
No pulse Pulseless VT · Go to Cardiac Arrest Algorithm
Expert Consultation Recommended
Wide QRS tachycardia in children — possible VT. Seek paediatric cardiology input.
If rhythm is regular and QRS monomorphic
Consider adenosine (may help diagnose and treat)
1ST DOSE
0.1 mg/kg
Max 6 mg · rapid push + flush
2ND DOSE
0.2 mg/kg
Max 12 mg · if 1st ineffective
Dose calc
🔢
If patient becomes unstable
Proceed to synchronised cardioversion — 0.5–1 J/kg
Antiarrhythmics — Last option · Seek expert first
Amiodarone IV/IO
5 mg/kg over 20–60 min
Dose calc
🔢
or
Procainamide IV/IO
15 mg/kg over 30–60 min
Dose calc
🔢
Bradycardia With a Pulse
👶 PALS 2025 — Paediatric
Entry Condition
Child with bradycardia AND a pulse
Heart rate <60 / min
Cardiopulmonary compromise?
Acutely altered mental status
Signs of shock
Hypotension
Bradycardia — Paediatric
No
Compromise
No cardiopulmonary compromise · PALS 2025
Identify and treat underlying causes
Support ABCs
Consider oxygen
Consider 12-lead ECG
Observe — reassess if status changes
Possible Causes
Hypothermia
Hypoxia
Toxins / medications
Raised ICP
Increased vagal tone
Heart block
Physiologic / appropriate
Bradycardia — Paediatric
Step
1 of 3
Assessment & Support · PALS 2025
Assessment and Support
A — Airway
Support or open the airway · Perform manual airway manoeuvre if needed
B — Breathing
Give O₂ in high concentration · Use NRB mask if available
Assist ventilation if needed (BVM)
Attach pulse oximetry · Check SpO₂
C — Circulation
Monitor BP · Assess perfusion
Establish IV / IO access
12-lead ECG — do not delay therapy
Send labs
Possible Causes
Hypothermia
Hypoxia
Toxins / medications
Raised ICP
Increased vagal tone
Heart block
Physiologic / appropriate
Bradycardia — Paediatric
Step
2 of 3
Persistent Bradycardia · PALS 2025
Bradycardia persists with cardiopulmonary compromise?
Acutely altered mental status
Signs of shock
Hypotension
Bradycardia — Paediatric
No persistent compromise · PALS 2025
Identify and treat underlying causes
Support ABCs
Consider oxygen
Consider 12-lead ECG
Observe — reassess if clinical status changes
Bradycardia — Paediatric
Step
3 of 3
Treatment · PALS 2025
Start CPR if HR <60
Begin chest compressions immediately — do not wait for drugs.
Epinephrine IV / IO
Dose 0.01 mg/kg
Conc. 0.1 mg/mL
Max 1 mg
Repeat Every 3–5 min
Dose calc
🔢
If persistent bradycardia — Infusion
Rate 0.1–0.3 mcg/kg/min
Titrate to response
Dose calc
🔢
Atropine IV / IO
Indication
Increased vagal tone · Primary AV block
Dose 0.02 mg/kg
Min 0.1 mg
Max 0.5 mg per dose
Repeat Once after 3–5 min
Max total Child 1 mg · Adolescent 3 mg
Dose calc
🔢
Consider Pacing
Identify and treat underlying causes
Consider transthoracic / transvenous pacing
🔁 Check Pulse Every 2 Minutes
✓ YES — Pulse present
Continue monitoring & reassess
✗ NO — No pulse
Go to Paediatric Cardiac Arrest Algorithm
Epinephrine Infusion
Rate Calculator · Paediatric · 0.1–0.3 mcg/kg/min
0.10 mcg/kg/min
0.1 1.0
Infusion Rate
— mL/hr
Tachyarrhythmia Algorithm
AHA ACLS 2025 Guideline Based
Assess for tachyarrhythmia:
Heart rate typically ≥150 / min
Clinically appropriate for patient's condition
Does this patient meet criteria for tachyarrhythmia?
Tachyarrhythmia Algorithm
Step
1 of 4
Identify & Treat Underlying Cause · AHA 2025
Initial Assessment — ABCDE
A: Airway patent?
B: Assess breathing — Rate, Depth, Pattern, SpO₂
Administer O₂ if hypoxaemic (SpO₂ <94%)
C: Cardiac monitor — HR, Rhythm, BP, ECG
D: Drugs — Obtain IV access
E: 12-lead ECG — don't delay treatment
Tachyarrhythmia Algorithm
Step
2 of 4
Persistent Tachyarrhythmia · AHA 2025
Is the persistent tachyarrhythmia causing any of the following?
Hypotension
Acutely altered mental status
Signs of shock
Ischaemic chest discomfort
Acute heart failure
Tachyarrhythmia Algorithm
Step
3 of 4 Unstable
Synchronized Cardioversion · AHA 2025
Synchronized Cardioversion
Don't forget to synchronise the defibrillator
Sedation — consider before cardioversion
Consent to be taken if patient conscious
Crash cart to be ready
Energy levels for cardioversion:
Atrial Fibrillation 200 J
Atrial Flutter 200 J
Narrow-complex tachycardia 100 J
Monomorphic VT 100 J
Polymorphic VT
Unsynchronised high-energy shock (defibrillation)
Narrow Regular Rhythm — Consider Adenosine
FIRST DOSE
6 mg IV push
Rapid · follow with NS flush
SECOND DOSE
12 mg IV push
If 1st dose ineffective · NS flush
⚠ Caution
Contraindicated in asthma / severe bronchospasm
Via central line — reduce first dose to 1 mg
Tachyarrhythmia Algorithm
Step
4 of 4Unstable
If Refractory · Antiarrhythmic Infusions · AHA 2025
If Refractory — Consider
Search for and treat underlying cause
Increase energy level for next cardioversion
Add antiarrhythmic drug
Expert consultation
Antiarrhythmic Infusions
Give only one of the following
Keep crashcart / defibrillator ready
Procainamide IV
20–50 mg/min until arrhythmia suppressed, hypotension, QRS widens >50%, or max 17 mg/kg given
Maintenance: 1–4 mg/min
Caution: Avoid if prolonged QT or CHF · Do not infuse faster than 50 mg/min
Amiodarone IV
150 mg over 10 minutes — repeat if VT recurs
Maintenance: 1 mg/min for first 6 hours
Adenosine IV
Narrow regular tachycardia · AHA 2025
FIRST DOSE
6 mg rapid IV push
Follow immediately with NS flush
SECOND DOSE
12 mg rapid IV push
If first dose ineffective · follow with NS flush
⚠ Caution
Contraindicated in asthma / severe bronchospasm
If giving via central line — reduce dose to 1 mg (first dose)
Refractory Tachyarrhythmia
If cardioversion unsuccessful · AHA 2025
Search for and treat underlying cause
Increase energy level for next cardioversion
Add antiarrhythmic drug
Expert consultation
Antiarrhythmic Infusions
Unstable · Wide QRS
Stable Wide-QRS Tachycardia · AHA 2025
Give only one of the following
Keep crashcart / defibrillator ready
Procainamide IV
Loading 20–50 mg/min until arrhythmia suppressed, hypotension, QRS widens >50%, or max 17 mg/kg given
Maintenance 1–4 mg/min
Avoid if Prolonged QT or CHF
Rate limit Do not infuse faster than 50 mg/min
Amiodarone IV
First dose 150 mg over 10 minutes — repeat if VT recurs
Maintenance 1 mg/min for first 6 hours
Tachyarrhythmia Algorithm
Step
3 of 4Stable
QRS Assessment · AHA 2025
Is the QRS wide?
QRS ≥ 0.12 seconds
≥ 3 small squares on ECG
Stable Wide QRS Tachycardia
Step
4 of 4
AHA 2025
If Regular and Monomorphic — Consider
Adenosine — only if regular and monomorphic
Antiarrhythmic infusion
Expert consultation
Adenosine IV doses
FIRST DOSE
6 mg IV push
Rapid · NS flush
SECOND DOSE
12 mg IV push
If 1st dose ineffective · NS flush
⚠ Caution
Contraindicated in asthma / severe bronchospasm
Via central line — reduce first dose to 1 mg
Antiarrhythmic Infusions
Give only one of the following
Keep crashcart / defibrillator ready
Procainamide IV
20–50 mg/min until arrhythmia suppressed, hypotension, QRS widens >50%, or max 17 mg/kg given
Maintenance: 1–4 mg/min
Caution: Avoid if prolonged QT or CHF · Do not infuse faster than 50 mg/min
Amiodarone IV
150 mg over 10 minutes — repeat if VT recurs
Maintenance: 1 mg/min for first 6 hours
Stable Narrow QRS Tachycardia
Step
4 of 4
AHA 2025
Management
Vagal manoeuvres — if regular
Adenosine — if regular
Beta-blocker or calcium channel blocker
Consider expert consultation
Adenosine IV doses
FIRST DOSE
6 mg IV push
Rapid · NS flush
SECOND DOSE
12 mg IV push
If 1st dose ineffective · NS flush
⚠ Caution
Contraindicated in asthma / severe bronchospasm
Via central line — reduce first dose to 1 mg
Infusion Rate Calculator
5 20
Infusion Rate
— ml/hr
Bradyarrhythmia Algorithm
AHA ACLS 2025 Guideline Based
Assess for bradyarrhythmia:
Heart rate typically <50 / min
Clinically appropriate for patient's condition
Does this patient meet criteria for bradyarrhythmia?
⚠️ CPR Stopped
0
seconds without compressions
⚡ Resume CPR as soon as possible
💜
Confirm Amiodarone
300 mg IV — 1st dose
⏰ Amiodarone
Time for 2nd Dose?
150 mg IV — 2nd dose
⚡ VF
Shockable Rhythm Detected
Stop CPR — Assess Now
10
🫁 Breathing 🫀 Pulse 📈 Rhythm
📈 Select Rhythm — tap to choose
⚠️ Sample tracings — real rhythms vary. Use clinical judgement.
🫀 Pulse Present?
🫀
Start CPR
Begin chest compressions immediately
Rate 100–120 / min
Depth ≥5 cm / 2 in
Compression : Ventilation
1 rescuer 30 : 2
(if bag-mask device)
Initial Rhythm?

Select the presenting rhythm to begin ACLS protocol

⚠️ Sample tracings — real rhythms vary. Use clinical judgement.
VF
Ventricular FibrillationShockable
pVT
Pulseless Ventricular TachycardiaShockable
Asystole
No Electrical ActivityNon-shock
PEA
Pulseless Electrical ActivityNon-shock
Rhythm Check in 15s
Prepare before CPR ends
⚡ Charge the defibrillator and be ready
👤 Next compressor — get ready to rotate
🫀
Feel the femoral pulse during CPR
Assesses compression efficacy — not palpable means inadequate compressions or hypovolaemia · If felt during CPR, ROSC is easier to confirm at rhythm check
⚠️
Non-Shockable Rhythm!
Current rhythm is non-shockable (PEA / Asystole). Defibrillation is NOT indicated. Are you sure you want to deliver a shock?
⚡
Confirm Shock Delivered?
Energy: —
⚠️ All clear — ensure no one is touching patient
Actual energy delivered (adjust if needed)
J
💊
3rd Shock Delivered
Consider antiarrhythmic — Amiodarone 300 mg or Lignocaine 1.0–1.5 mg/kg IV
💉
Epinephrine Advised
First dose not yet given — administer as soon as access available
⚠️
Too Soon?
Only 0:00 since last dose — minimum interval is 3–5 min. Give anyway?
💉
Confirm Epinephrine
Administer now?
🫁
Confirm Airway
5 min elapsed — select current airway device
⏱
Time of Airway Change
When was this device placed?
Select time
🧪
ABG / VBG
Has a blood gas been obtained? — 8:00 elapsed
Vagal Manoeuvre Techniques
AHA 2025 · Regular narrow QRS tachycardia
Standard Techniques
Valsalva Manoeuvre
Ask patient to blow hard into a 10 mL syringe (or similar resistance) for 15 seconds · or bear down as if straining
Carotid Sinus Massage
Firm circular massage over carotid sinus (below angle of jaw) for 5–10 seconds
⚠ Caution: Risk of stroke if carotid atherosclerosis present — check for bruits first
Modified / More Effective Approaches
REVERT Technique (Modified Valsalva)
Patient blows into syringe attached to sphygmomanometer, raising pressure to 40 mmHg for 15 sec · then immediately lie supine with passive leg raise to 45° for 15 sec
Passive Leg Elevation After Valsalva
Immediately after Valsalva strain: supine reposition + passive leg elevation to 45° for 15 seconds · augments vagal response
Epigastric Pressure
Press firmly over epigastric region for 10 seconds immediately after Valsalva
IV Rate Control Drugs
AF / Atrial Flutter · AHA 2025
Non-dihydropyridine Calcium Channel Blockers
Diltiazem
Bolus0.25 mg/kg IV over 2 min
Infusion5–10 mg/h
Avoid in hypotension, heart failure, cardiomyopathy, ACS
Verapamil
Bolus0.075–0.15 mg/kg IV over 2 min · repeat after 30 min if no response
Infusion0.005 mg/kg per min
Avoid in hypotension, heart failure, cardiomyopathy, ACS
Beta-Adrenergic Blockers
Metoprolol
Bolus2.5–5 mg IV over 2 min · up to 3 doses
Avoid in decompensated heart failure
Esmolol
Bolus500 mcg/kg IV over 1 min
Infusion50–300 mcg/kg per min
Short duration of action
Avoid in decompensated heart failure
Propranolol
Bolus1 mg IV over 1 min · up to 3 doses
Avoid in decompensated heart failure
Other Medications
Amiodarone
Bolus300 mg IV over 1 hour
Infusion10–50 mg/h over 24 h
Multiple dosing schemes exist
Digoxin
Bolus0.25 mg IV · repeat to max 1.5 mg over 24 h
Adjunctive therapy
Caution in renal impairment
LOGGED·
Cardiac Arrest Rhythms
AHA 2025 Guidelines
⚠️ Sample tracings — real rhythms vary. Use clinical judgement.
Shockable
Ventricular Fibrillation
Pulseless VT
Non-Shockable
PEA: No Pulse
Asystole
Algorithms
🧑 AHA 2025 — Adult
🏥
Select Patient Type
Before starting resuscitation
🤰
Optimise Resuscitation
Pregnancy-specific actions — confirm now
Left uterine displacement — if fundus at or above umbilicus
IV/IO access above diaphragm — avoid femoral/lower limb
If on IV MgSO₄ — stop infusion immediately
Give calcium gluconate 10 mL 10% IV if MgSO₄ was running
Detach fetal monitors
Obstetric + neonatal team called?
🤰
5 Minutes — PMCS Status
Has perimortem caesarean been performed?
Target delivery by 5 minutes from arrest onset
🤰
4 Minutes — PMCS Now
Perimortem Caesarean Section — target delivery by 5 min
Immediate Actions
4 min elapsed — initiate PMCS immediately
Call obstetric + neonatal team now · Perform at bedside — do not transfer to OT
Target delivery by 5 minutes from arrest onset (AHA 2025)
Continue CPR during and after delivery
PMCS relieves aortocaval compression — may improve maternal ROSC
Resuscitate newborn using Neonatal Resuscitation Algorithm (NRP)
🤰
Pregnant Patient — Immediate
Modified ACLS — AHA 2025
⏱ PMCS alert will fire at 4 minutes if no ROSC
🔪
Skin Incision
Log time for this PMCS milestone
Current Time
Or enter time manually (HH:MM)
Stop CPR
Select reason for stopping
Confirm?
Reset Epi Timer?
This will reset the epinephrine countdown timer.
Post-ROSC Checklist
Phase 1 of 3
Initial Stabilisation · AHA 2025
Airway
Endotracheal intubation done
Waveform capnography to confirm ETT
Respiration
Rate 10 breaths/min — titrate to achieve target PaCO₂
SpO₂ 90–98% / PaO₂ 60–105 mmHg targeted
PaCO₂ 35–45 mmHg targeted (if no severe acidaemia)
Haemodynamics
MAP >65 mmHg
IV Fluid bolus (1 - 2 L)
Inotrope / vasopressor given
Post-ROSC Care
Phase 1 of 3
Normoxia · Normocapnia · Circulation · 👶 PALS 2025
Normoxia & Normocapnia
SpO₂ 94–99% — avoid hyperoxia · wean O₂ once stable
PaCO₂ normalised — avoid hypo/hypercapnia · confirm ABG
Cardiac Function & Perfusion
Cardiac telemetry attached
Continuous arterial BP — target SBP & MAP >10th centile for age  
Serum lactate & urine output monitored
Fluid bolus ± vasopressors/inotropes to maintain BP
Epi 0.1–0.3 mcg/kg/min · Dopamine 2–20 mcg/kg/min
Echo — assess myocardial dysfunction
Electrolytes — maintain normal range
Review haemodynamic goals daily
Blood Glucose
Check glucose — avoid hypoglycaemia
Post-ROSC Care
Phase 2 of 3
TTM · Neuromonitoring · Sedation · 👶 PALS 2025
Targeted Temperature Management
Core temperature — continuous monitoring
Prevent & treat fever — keep <37.5°C
If comatose: TTM 32–34°C × 48 h, then 36–37.5°C (5 days total)
Prevent shivering
Rewarming — watch for hypotension · electrolytes · glucose · seizures
Neuromonitoring
Continuous EEG — detect subclinical seizures
Treat seizures promptly
Sedation & Analgesia
Sedatives · anxiolytics · analgesics — titrate to sedation score
Post-ROSC Care
Phase 3 — Neurological Status · PALS 2025
Is the patient following commands?
Post-ROSC Care
Phase 3 · Comatose
Neuroprotection · Prognostication · 👶 PALS 2025
Ongoing Critical Care
SpO₂ 94–99% · avoid hyperoxia
PaCO₂ — target normocapnia · avoid extremes
SBP and MAP >10th percentile for age
Avoid hypoglycaemia — monitor glucose
Review haemodynamic goals daily
Temperature Management
TTM 32–34°C for 48 h then 36–37.5°C — or only 36–37.5°C for 5 days total
Avoid hyperthermia >37.5°C — prevent and treat actively
Rewarming: watch for hypotension · electrolyte abnormalities · hypoglycaemia · seizures
Neuromonitoring
Continuous EEG — seizures common post-arrest in children · subclinical seizures require EEG to detect
Treat clinical and electrographic seizures promptly
Consider Prognosis
Always consider multiple modalities — no single test in isolation
Delay prognostication until at least 72 hours after cardiac arrest
Remember prognostic assessments may be modified by TTM
Post-ROSC Care
Phase 3 · Awake
Continued Management · 👶 PALS 2025
Ongoing Critical Care
SpO₂ 94–99% · PaCO₂ normalised
SBP and MAP >10th percentile for age
Avoid hypoglycaemia — monitor glucose
Maintain electrolytes within normal range
Review haemodynamic goals daily
Temperature
Avoid hyperthermia >37.5°C — monitor and treat actively
Monitoring
Continuous cardiac monitoring — watch for recurrent arrhythmia
Neurological assessment — document GCS / AVPU
Paediatric cardiology consult for ongoing management and underlying cause
Consider Prognosis
Multiple modalities — no single test in isolation
Delay prognostication until at least 72 hours after cardiac arrest
BP — 10th Centile Reference
Post-cardiac arrest target · AAP 2017 · PALS 2025
1 month
0m 18y
Minimum acceptable (10th centile)
SBP
—
mmHg
DBP
—
mmHg
MAP (approx)
—
mmHg
⚠️
Items Not Yet Done
The following Phase 1 items are still marked No. Proceed anyway?
Post-ROSC Checklist
Phase 2 of 3
Continued Management · AHA 2025
Early Diagnostic Testing
12-lead ECG obtained
Ischaemia present?
Arrhythmia present?
CT Chest / Head / Abdomen-Pelvis
POCUS / Echo performed
Post-ROSC Checklist
Phase 3 of 3
Continued Management — Comatose · AHA 2025
Ongoing Critical Care
Target PaO₂ 60–105 mmHg (avoid >250 mmHg)
Target PaCO₂ 35–45 mmHg (unless severe acidaemia)
Avoid hypoglycaemia (glucose <70 mg/dL)
Avoid hyperglycaemia (glucose >180 mg/dL)
Target MAP ≥65 mmHg
Consider antibiotics
Deliberate Temperature Control Strategy
Target temperature 32–37.5°C for at least 36 hours
(if rewarming: no faster than 0.5°C per hour)
EEG Monitoring
Continuous or intermittent EEG monitoring
Treat seizures if detected
Coronary Angiography
Consider coronary angiography when clinically appropriate — timing based on haemodynamic stability and suspected aetiology
Prognostication
Appropriately timed, multimodal prognostication
(not before 72 hours after normothermia / discontinuing sedatives)
Post-ROSC Checklist
Phase 3 of 3
Continued Management — Patient Awake · AHA 2025
Ongoing Critical Care
Target PaO₂ 60–105 mmHg (avoid >250 mmHg)
Target PaCO₂ 35–45 mmHg (unless severe acidaemia)
Avoid hypoglycaemia (glucose <70 mg/dL)
Avoid hyperglycaemia (glucose >180 mg/dL)
Target MAP ≥65 mmHg
Consider antibiotics
Target temperature 36–37.5°C (prevent fever)
Coronary Angiography
Consider coronary angiography when clinically appropriate — timing based on haemodynamic stability and suspected aetiology
🧠
Following Commands?
Is the patient following commands after ROSC?
Ensure sedation is weaned / off before assessing
Ensure neuromuscular blockade is reversed / off
Continued Management
Post-ROSC · AHA 2025
Treat Arrest Etiologies & Complications
Arrest etiologies identified and treated
Consider Emergent Cardiac Intervention if:
Persistent ST-segment elevation
Cardiogenic shock
Recurrent / refractory ventricular arrhythmias
Severe myocardial ischaemia
⚠️
Skip Post-ROSC Checklist?
The post-ROSC checklist helps ensure critical steps are not missed. Are you sure you want to skip?
⚠️
Close Checklist?
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Reversible Causes
5H · 5T — tap a cause to see treatments
5 H's
Hypoxia
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Hypovolaemia
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Hypo/HyperK
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Hypothermia
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H⁺ Acidosis
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5 T's
Tension PTX
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Tamponade
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Toxins
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PE
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Coronary (MI)
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Pregnancy Causes
Tap a cause to see treatment
Pregnancy
AAnaesthesia
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BBleeding
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CCardiovascular
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DDrugs
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EEmbolic
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FFever
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GGeneral Causes
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HHypertension
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Paediatric Causes
6H · 5T — tap a cause to see treatments
6 H's
Hypoxia
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Hypovolaemia
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Hypoglycaemia
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Hypo/HyperK
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Hypothermia
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H⁺ Acidosis
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5 T's
Tension PTX
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Tamponade
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Toxins
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Thrombosis — PE
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Thrombosis — MI
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Reversible Causes
10:00 elapsed — have you considered and addressed all 5H5T causes?
⚠️
Not Yet Advised
Amiodarone / Lignocaine is recommended only after the 3rd shock as per AHA guidelines. Only 0 shock(s) given so far. Do you still want to administer?
💊
Confirm Drug
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💙
Lignocaine Dose Calculator
1.0–1.5 mg/kg IV
Weight
kg
Concentration
Dose
Enter weight to calculate
Other Medications

Tap to mark administration — enter dose before confirming

🍬 Dextrose
Hypoglycaemia
0.5–1 g/kg IV
mL
⚗️ Sodium Bicarbonate (NaHCO₃)
Acidosis / Hyperkalaemia
50 mEq IV
mEq
🟧 Calcium Chloride (10%)
Hyperkalaemia / Ca²⁺-channel blocker OD
10 mL IV over 2–3 min · 100 mg/mL
mL
🟠 Atropine
Symptomatic Bradycardia
0.5–1 mg IV
mg
🟡 Magnesium Sulphate
Torsades de pointes
2 g IV over 10 min
g
🔴 Adrenaline Infusion
Post-ROSC · 0.01–1 mcg/kg/min · titrate to MAP >65 mmHg
mcg/min
🔴 Noradrenaline Infusion
Post-ROSC · 0.01–3 mcg/kg/min · vasopressor of choice
mcg/min
📝 Any Other Medicine
Enter drug name and dose — logged to event timeline
🩺 Procedures Log
Tap to log — adds timestamp to event timeline
Vascular Access
Airway Procedures
Chest Procedures
Monitoring & Diagnostics
Other Procedure
Confirm Procedure
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Arun Anaesthesia Academy
ACLS PROTOCOL
Based on AHA 2025 Guidelines
Start Code Blue
Select patient type & begin
›
Past Sessions
View & download logs
›
Algorithms
Post-ROSC — Brady — Tachy
›
Arrest Rhythms
VFib — pVT — PEA — Asystole
›
Reversible Causes
5H — 5T  ·  Adult — Pregnancy — Paed
›
Paediatric Reference
Drug doses — Defib — Equipment
›
User Manual
How to use — Tips — Workflow
›
Dr. Arun Chandran Nhattuvalappil
Founder · Arun Anaesthesia Academy
Specialist Anaesthesiologist · UAE & India
© 2026 Arun Anaesthesia Academy  ·  v2.6
For educational & clinical decision support use only
Paediatric Reference
Broselow / Weight-based
⚡ Shock Delivery
Shocks
0
Energy
—
💊 Medications
💜 Amiodarone
💙 Lignocaine
🧪 Other Medications MgSO₄ · Atropine · NaHCO₃
🫁 AIRWAY AND PROCEDURES
🫁 Present airway device: Bag Mask Ventilation
🩺 Procedures
ALGORITHMS
📈 Cardiac Arrest Rhythms
⚠️ Sample tracings — real rhythms vary. Use clinical judgement.
⚡ Shockable
Ventricular Fibrillation
Pulseless VT
🚫 Non-Shockable
PEA: No Pulse
Asystole
🔍 Reversible Causes – 5H5T · tap a cause to see treatments
5 H's
Hypoxia
›
Hypovolaemia
›
Hypo/HyperK
›
Hypothermia
›
H⁺ Acidosis
›
5 T's
Tension PTX
›
Tamponade
›
Toxins
›
PE
›
Coronary (MI)
›
✅ ROSC Achieved
ROSC Time—
Code Duration—

✓ 12-lead ECG  |  ✓ SpO₂ 94–98%
✓ Avoid hypotension (MAP ≥65 mmHg)
✓ Targeted temperature management
✓ Consider PCI / treat underlying cause

📊 Resuscitation Summary
0
CPR Cycles
0
Shocks
0
Epinephrine
0
Antiarr.
0
0
In progress
Started—
—
Time Code+ Event · Details
Start Code Blue to begin logging
📝 Notes
🫀
Torsades de Pointes?
2nd antiarrhythmic given + shockable rhythm — consider Torsades de Pointes
Torsades de Pointes — polymorphic VT with QT prolongation. Treatment: MgSO₄ — Adult: 2 g IV over 5–10 min · Paediatric: 25–50 mg/kg IV/IO over 10–20 min (max 2 g).
🫁
Advanced Airway In Place
🫀
Compressions
100–120 / min — continuous, uninterrupted
🫁
Ventilation
10 breaths / min — 1 breath every 6 seconds
🚫
30:2 ratio not required
Do not pause compressions to ventilate
💬
WhatsApp
Select a number to connect
🇦🇪 UAE
+971 508 346 105
🇮🇳 India
+91 999 585 8938
⏱
End Code — Choose Outcome
Select how the resuscitation ended
📋
Past Sessions
Tap any session to download PDF
No past sessions yet
🩸
Check Blood Sugar
Target > 60 mg/dL  ·  Give dextrose if low
Blood Glucose Check
Paediatric reminder
Blood sugar checked?
Point-of-care glucose
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Drug Doses
Paediatric reference
Algorithms
Select patient type
Algorithms
👶 PALS 2025 — Paediatric
Changing Rhythm To
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—
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Change Rhythm
Reassessment — no pulse check triggered
⚠️ Sample tracings — real rhythms vary. Use clinical judgement.