1. MUSC Code Card: The 4-step Approach to ACLS
Matthew D. McEvoy, MD
John J. Schaefer, III, MD
Young Choi
Matthew Crumpler
Jenny Matos

2. 4 Easy Questions:
(Assess the following questions, then follow the numeric steps until the condition resolves, the__ condition changes to another ACLS pathway, or__ care is discontinued, consider H’s, T’s, etc)____
Pulse or Pulseless?
If pulseless, go the ‘Pulseless Rhythms’, begin CPR, assess rhythm for ACLS pathway, and treat accordingly.
If pulse present, go to Question 2
Is the patient Stable or Unstable?
Unstable = angina, SOB, altered mental status, presyncope/syncope, hypotension related to rhythm, signs of shock or CHF (usually HR>150bpm)
If Unstable with pulse, go to ‘Unstable Rhythms with Pulse’ section, assess rhythm and treat accordingly.
If Stable, go to questions 3 and 4.
3. Is the QRS complex Wide or Narrow?
4. Is the rhythm (R-R interval) regular or irregular?

3. Questions about Energy for Cardioversion, Defibrillation, or Transcutaneous Pacing
Flip the card over and find ‘Cardioversion, Defibrillation, and TCP Settings’ Section
*Use ‘Sync’ Mode except for Unstable Polymorphic VTach and VF/Pulseless VTach
**Make sure to declare ‘all clear’ prior to delivering shock
***If using TCP, also consult cardiology immediately

4. Questions about Drug Dosages, Routes, etc.
When treating patient according to ACLS pathways, consult back of card if uncertain about drug dosage, route of administration, maximum doses, and contraindications.