ACLS/MEGACODE
5 MAN TEAM ROLES
LEADER Intubate the patient Give
instructions:
● Order necessary Joules for defib
● Order medication + dose + route + frequency
● Perform rhythm check and interpretation
CPR/DEFIB First responder
Perform BLS and emergency code activation
CPR100-120 compressions per minute Shock at a
given Joules.
“Charging at [number] Joules. I’m clear, everybody clear? Shocking in 3, 2, 1. SHOCK
DELIVERED.”
Obtain 12-lead ECG when the patient is put on ventilator machine.
AIRWAY Assist in intubation Attach
ambu bag
Provide 5 breaths per minute
Put the patient on ventilator AS ORDERED.
IV/MEDS Establish IV/IO access Prepare, prime,
and hook fluids
Administer needed medications AS ORDERED. List of meds and dosage:
● Epinephrine - 1mg IV push q3-5 minutes; 2-10 mcg/min infusion
● Amiodarone - 300 mg lV slow IV push as loading dose, followed by 150-
150 once after 5 minutes *flush with 20mL NSS
● Lidocaine - (alternative for amio) initial dose of 1 to 1.5 mg/kg IV. Additional
doses of 0.5 to 0.75 mg/kg IV push may be administered at 5- to 10-minute
intervals, to a maximum dose of 3 mg/kg.
● Atropine - (for sinus brady) 1 mg IV q3-5 min. Max dose of 3mg
● Dopamine - (2nd line for sinus brady) 5-20 mcg/kg/min IV infusion
● Norepinephrine - (for hpt) 0.1 - 0.5 mcg/kg/min Addt’l:
● Adenosine - 6mg rapid IV push (6-12-12)
● Diltiazem (calcium channel blocker for afib aflutter) - 0.25mg/kg thru IV over
2 minutes
● Verapamil (for narrow complex)- 2.5 to 5 mg slow IV Push over 2 minute
● Magnesium Sulfate (if w/ pulse; if pulseless, defib!) - 1-2 grams IV mixed
with 50-100ml NSS to run over 5 to 60 minutes
● Procainamide (for wide complex) - 20 mg/min IV infusion or 100 mg every
5 mins
● Sotalol (wide complex) - 1.5 mg/kg IV infusion
● Dobutamine (cardiac dose) 5-10mkm IV infusion
RECORDER/ Put electrodes on the patient
MONITOR Record everything every 2 minutes
Monitor and verbalize patient vitals, capnography waveform, etc.
Announce the time before next rhythm check
Inform the team if rhythm check is needed (2-minute cycle is over)
1 | YOJ CUTE (+KUYA ESSREL)
ACLS/MEGACODE SCRIPT: [Link]
FIRST RESPO/CPR [YOJ]: Mr. Dela Cruz, can you hear me? Checking carotid pulse, I cannot feel any
pulse. *Check for abdomen* The patient is not breathing. The patient is unresponsive. We have an arrest
patient here, calling for code! Code blue! Code blue! Starting high-quality chest compression now.
[ACLS]
*All healthcare team enter*
LEADER: Anong oras nagcode? *kikilos lahat ng team habang nagsasalita* *intubate* *meds*
CPR: *say specific time*
LEADER: Code started at [time].
LEADER: Yoj, you are incharge of defibrillating, pls continue giving chest compressions and
maintain at least 60% CCF. Violet, you’ll manage the airway. Ace, establish IV line and prepare
meds. Cleodine, electrodes please. Record and monitor everything after that.
LEADER: Patient is intubated with tube size 7.5 at level 21. Verifying placement, checking for bilateral lung
sound positive-positive-negative epigastric region. Ok, ET tube is now in place. Violet, please attach ambubag
and give 1 breath every 5 seconds.
MEDS: IV line established. PNSS primed and hooked. I’m now giving patient fluids at fast drip
AIRWAY: I’m now giving the patient 1 breath per 5 seconds
RECORDER: Electrodes placed.
LEADER: Time check, ilang minutes bago mag-rhythm check?
RECORDER: [say time]
LEADER: stop compression, rhythm check. Okay let’s analyze, switch roles.
*IF SHOCKABLE RHYTHM*
[1] CODE FOR EPI GIVEN [Epi-1]
LEADER: The patient is blah blah blah *rhythm check* *rhythm interpretation*
LEADER: Shock the patient at 200J, followed by high quality CPR, and administer epi 1, 1 mg IV now, we
will give epi every 3-5 mins!
*CPR WHILE ADJUSTING JOULES, MAY SASAMPA TO CONTINUE CPR*
CPR: *include rubbing with jelly* Shock ready. Shocking the patient at 200J, I’m clear, are you all clear?
Shocking the patient in 3,2,1. Shock delivered.
LEADER: please continue delivering high quality chest compressions
MEDS: epi 1, 1mg IV given now.
LEADER: How many minutes until our next rhythm check?
RECORDER: [say time]
LEADER: stop compression. Rhythm check. Okay let’s analyze, switch roles.
[Epi-2]
LEADER: The patient is blah blah blah *rhythm check* *rhythm interpretation*
LEADER: Shock the patient at 200J, followed by high quality CPR, and prepare epi 2, 1 mg IV, 1 min from
now
*CPR WHILE ADJUSTING JOULES, MAY SASAMPA TO CONTINUE CPR*
CPR: *include rubbing with jelly* Shock ready. Shocking the patient at 200J, I’m clear, are you all clear?
Shocking the patient in 3,2,1. Shock delivered.
LEADER: please continue high quality chest compressions LEADER: How many minutes until our next
rhythm check?
RECORDER: [say time]
2 | YOJ CUTE (+KUYA ESSREL)
LEADER: stop compression. Rhythm check. Okay let’s analyze, switch roles.
[Epi-3 prep]
LEADER: The patient is blah blah blah *rhythm check* *rhythm interpretation*
LEADER: Shock the patient at 200J, followed by high quality CPR, and prepare epi 3, 1 mg IV, 2 mins from
now
*CPR WHILE ADJUSTING JOULES, MAY SASAMPA TO CONTINUE CPR*
CPR: *include rubbing with jelly* Charging. Shocking the patient at 200J, I’m clear, are you all clear? Shocking
the patient in 3,2,1. Shock delivered.
LEADER: please continue high quality chest compressions
LEADER: How many minutes until our next rhythm check?
RECORDER: [say time]
LEADER: stop compression. Rhythm check. Okay let’s
analyze, switch roles.
MEDS: Epi 3 given. [HOLD IF SINUS BRADY]
[Epi-3 administration]
LEADER: The patient is blah blah blah *rhythm check* *rhythm interpretation*
LEADER: Shock the patient at 200J, followed by high quality CPR.
CPR: Shocking the patient at 200J, I’m clear, are you all clear? Shocking the patient in 3,2,1. Shock delivered.
*include rubbing with jelly*
*CPR WHILE ADJUSTING JOULES, MAY SASAMPA TO CONTINUE CPR*
LEADER: please continue high quality chest compressions and administer the epi 3 now.
LEADER: How many minutes until our next rhythm check?
RECORDER: [say time]
LEADER: stop compression. Rhythm check. Okay let’s analyze, switch roles.
[AFTER EPI 3 - AMIODARONE]
LEADER: The patient is blah blah blah *rhythm check* *rhythm interpretation*
LEADER: Shock the patient at 200J, followed by high quality CPR. Ilang minutes na nagrurun ang epi
natin?
*CPR WHILE ADJUSTING JOULES, MAY SASAMPA TO CONTINUE CPR*
MEDS: 2 mins po
LEADER: Okay, administer amiodarone, 300 mg as loading dose, slow IV push, now!
CPR: *include rubbing with jelly* Shocking the patient at 200J, I’m clear, are you all clear? Shocking the
patient in 3,2,1. Shock delivered.
LEADER: please continue high quality chest compressions
LEADER: How many minutes until our next rhythm check?
RECORDER: [say time]
LEADER: stop compression. Rhythm check. Okay let’s analyze, switch roles.
*IF NON-SHOCKABLE*
[IF PEA OR ASYSTOLE]
LEADER: The patient is PEA/Asystole
3 | YOJ CUTE (+KUYA ESSREL)
LEADER: Continue HQCPR maintain the 2inch depth, and administer epinephrine 1mg IV now.
MEDS: Administering 1 mg IV epi now.
LEADER: How is the patency of the IV line?
MEDS: IV line is still patent and in.
LEADER: How many minutes until our next rhythm check?
RECORDER: [say time]
LEADER: stop compression. Rhythm check.
IF SINUS BRADY/TACHY
[IF SINUS TACHY, OBSERVE AND MONITOR]
[IF SINUS BRADY, CHECK IF STABLE OR UNSTABLE. IF UNSTABLE]
LEADER: The patient is now in sinus bradycardia. How is the patient’s vitals?
RECORDER: The patient is unstable, BP *state bp*
LEADER: Ok let’s administer Atropine 1mg IV every 3-5 minutes. Then let’s observe if the patient’s
condition improves.
[IF STILL UNSTABLE AFTER 3 DOSES]
LEADER: The patient is still unstable after 3 doses of Atropine. We should consider Epi 2-10 mcg/min for
infusion.
MEDS: We are out of epi. Should I infuse dopamine instead?
LEADER: Yes, please infuse 5-10 mcg/kg/min dopamine now. Then let’s observe the patient.
ROSC & PCAC
LEADER: Okay, we have a return of spontaneous circulation. Let’s put the patient on a ventilator and check
the patient’s waveform capnography and blood pressure.
CPR: can we obtain a 12-lead ECG now?
AIRWAY: I’m putting the patient on a ventilator machine. Starting 10 breaths per minute.
RECORDER: The patient’s entitled CO2 is [value]
LEADER: Titrate the FiO2 for 98% SpO2, and to PaCO2 of 36* mmHg. Make sure we do not hyperventilate
the patient.
LEADER: How is the BP? [If hypotensive]
RECORDER: The patient is still hypotensive with a BP of [value]. LEADER: Ok is our IV line still functional?
MEDS: *while inserting new cannula* The patient’s IV line is no longer patent. I’m now trying to access
another one. I’m in.
LEADER: Good. Let’s infuse 2 liters of normal saline IV bolus. If the patient’s hypotension does not improve,
please prepare norepinephrine 0.1-0.5 mcg/kg/min.
MEDS: I’m on it.
LEADER: How is our ECG reading?
CPR: The reading has negative STEMI and does not show indications for myocardial infarct.
[NOTE: If may +STEMI or AMI, prepare for coronary reperfusion refer sa cath lab]
LEADER: Good. Our BP?
RECORDER: The patient’s BP has stabilized. Systolic [value], diastolic [value].
LEADER: Good job, team. We have to observe the patient and see if he will obey verbal commands.
[IF NOT, start targeted temperature management for hypothermia]
[IF YES, transfer the patient to the ICU for close monitoring and recovery]
4 | YOJ CUTE (+KUYA ESSREL)
Time Code Started: 8:58pm
Time Assessment Medication Intervention Remarks
Given
8:58pm Pulseless BLS
9:00pm Vfib Epinephrine ACLS Defibrillate @
1mg @ IV 9:00 200J
9:02pm Asystole Epinephrine 1mg ACLS HQCPR
IV @9:03
9:04pm VFib Amiodarone 300
mg slow IV push
@9:05
9:06 Pulseless Vtach Epinephrine 1mg ACLS Defibrillate @
IV @9:06 200J
9:08 Asystole Epinephrine 1mg ACLS HQCPR
IV @9:09
9:10pm Sinus bradycardia ACLS REVIVED
(/) Revived Date: 11/14/22 BP:90/60 HR: RR: Rhythm: Sinus
Bradycardia
Time: 9:10pm
Example:
Time Assessment Medication Intervention Remarks
Given
5 | YOJ CUTE (+KUYA ESSREL)
6 | YOJ CUTE (+KUYA ESSREL)
7 | YOJ CUTE (+KUYA ESSREL)
8 | YOJ CUTE (+KUYA ESSREL)
9 | YOJ CUTE (+KUYA ESSREL)
10 | YOJ CUTE (+KUYA ESSREL)