Adult code companion

All timers are differences between wall-clock timestamps, so they stay right if the phone locks the tab or throttles it. Elapsed runs from the first logged event. Rhythm check counts down 2 minutes from the latest start, rhythm check or shock, then turns red and counts up. Epinephrine shows time since the last dose: grey under 3 minutes, amber in the 3 to 5 minute window, red after 5.

Undo removes the last event and every number recomputes from the log. Nothing is stored or sent; closing the page clears it. The screen is kept awake while a code is running, if the browser allows it. Sound is off until you turn it on.

VF/pVT: one shock per rhythm check, with 2 minutes of compressions after each. Get IV or IO access in the first cycle. Epinephrine starts after the second shock and repeats every 3 to 5 minutes; that is also the time to think about an advanced airway with waveform capnography. After the third shock, give amiodarone or lidocaine and work the reversible causes. If the arrest began in asystole or PEA and later turns shockable, the antiarrhythmic prompt comes after the second shock.

Asystole/PEA: epinephrine as early as you can, repeated every 3 to 5 minutes, with 2-minute compression cycles, IV or IO access, an airway with capnography when CPR is running well, and a running search for the cause. Each check is a decision: shockable, shock; organized rhythm, feel for a pulse for no more than 10 seconds.

Energy: biphasic at the manufacturer's dose (for example, 120 to 200 J), or the maximum if unknown; later shocks equivalent, higher may be considered. Monophasic 360 J. Drugs: epinephrine 1 mg; amiodarone 300 mg then 150 mg; or lidocaine 1 to 1.5 mg/kg then 0.5 to 0.75 mg/kg.

CPR: 100 to 120/min, at least 5 cm (2 in) but not more than 6 cm (2.4 in), full recoil, compression fraction of at least 60%, 30:2 without an advanced airway, 1 breath every 6 seconds with one, switch compressors about every 2 minutes.

The BLS, ALS and universal termination rules are for out-of-hospital EMS use. The 2025 text calls them inappropriate where they were not validated, including in-hospital arrest, overdose and trauma.

Intubated: ETCO₂ that never rises above 10 mm Hg after 20 minutes of ALS may be one part of a multimodal decision (Class 2b). Not intubated: do not use any ETCO₂ cutoff to stop (Class 3: Harm). ETCO₂ alone never decides.

Only items the 2025 text itself marks as new or changed:

• AF and flutter cardioversion start at 200 J. Part 9 notes that earlier guidelines deferred biphasic energy to the manufacturer.
• Drug delivery through an endotracheal tube was removed (Part 9, take-home message 6).
• Termination guidance was updated: rules matched to EMS scope, and ETCO₂ never used alone (Part 9, take-home message 3).
• Post-ROSC blood pressure: the earlier systolic target was removed; the goal is MAP of at least 65 mm Hg (Part 11).
• Post-ROSC temperature control, mechanical support, coronary angiography, ventilation and vasopressor choice were updated; myoclonus is a new section (Part 11 scope).
• Pregnancy: "resuscitative delivery" replaces "perimortem cesarean delivery", and preparation starts when the arrest is recognized (Part 10). The 4- to 5-minute interval itself dates from 1986.

This page restates 2025 AHA recommendations in its own words. It is not the AHA algorithm, is not affiliated with or endorsed by the AHA, and is not a substitute for certified AHA training. Calcium, bicarbonate, naloxone and lipid emulsion doses shown are the 2025 Part 10 Table 4 reference doses for the poisonings named, and insulin-dextrose is from Table 3 (hyperkalemia); the 2025 text gives no calcium dose for hyperkalemia or magnesium toxicity and no magnesium dose. Events are logged by name. Use your hospital's dosing.