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Free · Reflects current resuscitation science · Quick reference

Code blue, walked through. Fast.

Our own plain-language walkthrough of adult basic and advanced cardiac life support (cardiac arrest, bradycardia, tachycardia, post-arrest care) and pediatric resuscitation. Built for studying and quick recall between hands-on courses — it does not replace a certification course or your facility's protocol.

Adult Basic Life Support (BLS)

  1. Make the scene safe — confirm it's safe to approach before you do anything else.
  2. Check for a response — tap the shoulder and shout. At the same moment, watch for breathing and feel for a carotid pulse (no more than 10 sec).
  3. Call for help — trigger the code and send someone for the AED and crash cart.
  4. Start compressions:
    Hand position: heel of one hand on the lower half of the breastbone, the other hand stacked on top, elbows locked. Press 2-2.4 in (5-6 cm) deep at 100-120/min, let the chest rebound fully each time, and keep any pauses under 10 sec.
    Ratio: 30 compressions to 2 breaths until an advanced airway is placed, then compress continuously with 1 breath every 6 sec.
  5. Get the AED on early: power on → place pads (upper right chest + lower left side/armpit) → let it read the rhythm → shock if it advises → go straight back to compressions the instant the shock is delivered.
  6. Trade off the compressor every 2 min (about 5 cycles) so fatigue doesn't drop your quality.
  7. Keep going until the patient regains a pulse (ROSC), the advanced team takes over, or stopping criteria are met.
What "high-quality" actually means: push hard and fast, allow full recoil between each compression, interrupt as little as possible, and resist the urge to over-ventilate. Doing those well matters more than nailing a perfect ratio.

Advanced Cardiac Life Support — Cardiac Arrest

Step 1 — Confirm the arrest, start CPR, get the monitor on

No pulse? → CPR + O2 + monitor/defib pads, and get IV/IO access going.

Step 2 — Sort the rhythm into shockable vs. not

SHOCKABLE: VF or pulseless VT
  1. Shock (biphasic 120-200 J, monophasic 360 J), then go right back to compressions.
  2. CPR × 2 min; get IV/IO access if you don't have it yet.
  3. Re-check the rhythm — still shockable? Shock → Epinephrine 1 mg IV/IO q3-5 min → CPR × 2 min.
  4. Re-check again — still shockable? Shock → Amiodarone 300 mg IV/IO (or Lidocaine 1-1.5 mg/kg) → CPR × 2 min.
  5. For the next antiarrhythmic dose use Amiodarone 150 mg IV/IO; keep Epi going q3-5 min the whole time.
  6. Hunt for and fix reversible causes (the H's and T's).
NOT shockable: Asystole / PEA
  1. CPR × 2 min, IV/IO access, and Epinephrine 1 mg IV/IO q3-5 min.
  2. Chase reversible causes right away — PEA has more fixable causes than VF does.
  3. Re-check the rhythm every 2 min; if it turns shockable, switch to the shockable pathway.
  4. Before you call asystole: confirm a flat line in two leads and turn the amplitude up first.

The reversible causes (H's and T's)

5 H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia.
5 T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary).

Once there's an advanced airway

  1. Switch to continuous compressions with 1 breath every 6 sec (10/min).
  2. Confirm tube placement with waveform capnography (EtCO2) — it's the most reliable check.
  3. An EtCO2 that stays under 10 mmHg after 20 min of CPR is a poor prognostic sign.
  4. Don't stop compressions to intubate — slip in an LMA or other supraglottic device instead if needed.

Bradycardia with a Pulse

Spot it: HR < 50 that's causing symptoms

Signs the slow rate is unstable: low blood pressure, altered mental status, ischemic chest pain, acute heart failure, or other signs of shock.

What to do

  1. Monitor, run the ABCs, give O2 if needed, and get IV access.
  2. Atropine 1 mg IV bolus, repeated q3-5 min up to a max of 3 mg total.
    Don't count on atropine in: Mobitz Type II 2nd-degree AV block, 3rd-degree AV block, or infranodal blocks — move straight to pacing.
  3. If atropine doesn't work or isn't appropriate, pick one:
    • Transcutaneous pacing — set the rate 60-80, start the current at 50 mA and climb until you get capture, and sedate the patient.
    • Dopamine infusion 5-20 mcg/kg/min
    • Epinephrine infusion 2-10 mcg/min
  4. Definitive care: transvenous pacing, loop in cardiology, and treat whatever's driving it.

Tachycardia with a Pulse

Spot it: HR > 150 that's causing symptoms?

Unstable (low BP, altered mental status, chest pain, heart failure, shock) → go to SYNCHRONIZED cardioversion right away.
  • Narrow & regular (SVT): 50-100 J, then step up
  • Narrow & irregular (AFib with RVR): 120-200 J biphasic
  • Wide & regular (VT with a pulse): 100 J, then step up
  • Wide & irregular (polymorphic VT): handle it like VF — DEFIBRILLATE (unsynchronized), don't sync.

Stable — look at the QRS width

Narrow & regular (likely SVT):
  1. Start with vagal maneuvers (Valsalva; the modified Valsalva with a leg lift afterward improved conversion in the REVERT trial).
  2. Adenosine 6 mg IV rapid push, chased with a 20 mL NS flush and arm elevation. Can follow with 12 mg, then another 12 mg.
  3. Still in SVT? Move to a beta-blocker or a calcium channel blocker.
Wide & regular (likely VT, or SVT conducting aberrantly):
  1. When in doubt, treat it as VT: Amiodarone 150 mg IV over 10 min.
  2. Or use Procainamide 20-50 mg/min until the rhythm breaks or you hit the 17 mg/kg max.
  3. Get cardiology involved — it will likely need cardioversion or pacing.
Irregular (likely AFib): control the rate with diltiazem or metoprolol, and weigh anticoagulation using the CHA2DS2-VASc score.

Care After ROSC (the patient got a pulse back)

  1. Dial in breathing and oxygen — aim for SpO2 92-98% and EtCO2 35-45 mmHg, and steer clear of over- or under-ventilating.
  2. Support the blood pressure — keep MAP ≥ 65 with IV fluids and vasopressors as needed.
  3. Run a 12-lead EKG to catch a STEMI → activate the cath lab emergently.
  4. Targeted temperature management (TTM): for patients who stay comatose after any-rhythm arrest, hold a temperature of 32-36°C (89.6-96.8°F) for 24 hr, then rewarm slowly at 0.25°C/hr and keep fever away.
  5. Continuous EEG — seizures show up in roughly 5-20% of these patients.
  6. Keep glucose 144-180 mg/dL and don't let them go hypoglycemic.
  7. Hold off on neuroprognostication for at least 72 hr after rewarming, and use several inputs together — exam, EEG, NSE, imaging.
Talking with family: early, honest, and often. The picture is genuinely uncertain in the first 72 hr, so avoid withdrawing life-sustaining therapy too soon.

Pediatric Resuscitation (PALS)

Pediatric basic life support — where it differs from adults

  1. Compression depth: about 1/3 of the chest's front-to-back diameter (~1.5 in in an infant, ~2 in in a child).
  2. Ratio: 30:2 with a single rescuer; 15:2 with two rescuers (both infants and children).
  3. Where to check the pulse: brachial in an infant; carotid or femoral in a child.
  4. Alone with a sudden, witnessed collapse? Call for help FIRST. If it wasn't witnessed, do 2 minutes of CPR before you step away to call — peds arrests are usually respiratory in origin.

Pediatric cardiac arrest — usually starts with the airway

  1. For VF/pulseless VT in a child: shock at 2 J/kg first, then 4 J/kg, then ≥ 4 J/kg (cap at 10 J/kg or the adult dose).
  2. Epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of the 1:10,000 concentration) q3-5 min.
  3. Amiodarone 5 mg/kg IV/IO for VF/pulseless VT that won't break; can repeat up to 2 more times (max 15 mg/kg/day).
  4. Be aggressive with the airway — most pediatric arrests begin as respiratory failure.

Dosing when you don't know the weight

If the child's weight is unknown, use a length-based dosing tape (e.g., Broselow) to estimate doses by length/age — most reliable up to about 12 yr.

Catch pediatric shock early

  1. Compensated: fast heart rate, cool or mottled limbs, slow capillary refill, and dropping urine output — the blood pressure can still look normal.
  2. Decompensated (hypotensive): SBP below 70 + (2 × age in years) for ages 1-10 — this is a late, ominous sign.
  3. Treat shock hard and early — 20 mL/kg isotonic fluid bolus, reassess, and repeat up to 3 times if needed (consistent with the pediatric Surviving Sepsis guidance).

Code Meds Quick Reference

EpinephrineCardiac arrest: 1 mg IV/IO (10 mL of 1:10,000) q3-5 min. Anaphylaxis: 0.3-0.5 mg IM 1:1,000. Infusion: 0.01-0.5 mcg/kg/min.
AmiodaroneVF/pulseless VT: 300 mg IV/IO bolus, repeat 150 mg. Stable VT/SVT: 150 mg over 10 min → 1 mg/min × 6 hr → 0.5 mg/min × 18 hr.
AtropineBradycardia: 1 mg IV q3-5 min, max 3 mg total. NOT for high-degree AVB.
AdenosineSVT: 6 mg IV rapid push + 20 mL NS flush. Repeat 12 mg, then 12 mg. Half-life 10 sec.
LidocaineAlternative to amiodarone for VF/VT: 1-1.5 mg/kg IV/IO bolus, repeat 0.5-0.75 mg/kg q5-10 min, max 3 mg/kg.
Magnesium sulfateTorsades de pointes: 1-2 g IV over 5-20 min (push for arrest). Hypomagnesemia VF/VT: 1-2 g IV.
Calcium chlorideHyperkalemia, Ca-channel blocker tox, hypocalcemia: 0.5-1 g IV slow push. Central line preferred.
Sodium bicarbonateHyperkalemia, TCA OD, severe metabolic acidosis: 1 mEq/kg IV. NOT routine in arrest (delayed restoration of cellular pH).
NaloxoneOpioid OD: 0.4 mg IV/IM titrated, or 4 mg IN. Q2-3 min. Goal = respirations restored.
VasopressinNo longer part of the adult cardiac-arrest sequence in current guidance. Used as an add-on to norepinephrine in septic shock: 0.03-0.04 units/min, fixed.
This is study and quick-reference material — it is not a certification course. Formal basic and advanced life-support certification requires hands-on training. Always follow your own facility's code protocol. Doses shown are for ADULTS unless noted otherwise; pediatric doses are weight-based, so verify every one before giving it. BrainSheets is an independent resource and is not affiliated with, sponsored by, or endorsed by the American Heart Association. "BLS," "ACLS," and "PALS" are used here as general clinical terms for the levels of resuscitation; this summary was written in our own words from current resuscitation science (sources below).

References (APA)

American Heart Association. (2020). 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl 2), S337-S604. https://doi.org/10.1161/CIR.0000000000000916
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., ...Berg, K. M. (2020). Part 3: Adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl 2), S366-S468.
American Heart Association. (2023). 2023 focused updates on adult cardiopulmonary resuscitation and emergency cardiovascular care: Targeted temperature management. Circulation, 148.
Topjian, A. A., Raymond, T. T., Atkins, D., Chan, M., Duff, J. P., Joyner, B. L., ...Schexnayder, S. M. (2020). Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl 2), S469-S523.
Appelboam, A., Reuben, A., Mann, C., Gagg, J., Ewings, P., Barton, A., ...Benger, J. (2015). REVERT trial: Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias. Lancet, 386(10005), 1747-1753.