1. Unresponsive / Unconscious Patient   ==> Tap & shout → Call 911/code team → Open airway (head-tilt/chin-lift) → Check pulse & breathing → Start CPR if absent → Attach AED

2. Cardiac Arrest (VF/pVT)  ==> Confirm pulseless → Begin high-quality CPR → Attach defibrillator → Shock → Resume CPR 2 min → Epinephrine 1 mg IV → Amiodarone 300 mg IV  [V-FIB -> CPR-SHOCK-CPR-Epi- A-mio]

3. Cardiac Arrest (Asystole/PEA) ==> Confirm pulseless → Begin CPR → Epinephrine 1 mg IV q3–5 min → Identify reversible causes (H's & T's) → Continue CPR cycles → Reassess rhythm q2 min [CPR->Epi + Tx REVERSIBLE CAUSES

4. Acute Stroke Symptoms ==> Note symptom onset time → Call 911 → Perform stroke scale (FAST) → Obtain STAT CT head → Check glucose → tPA if eligible within window

5. Anaphylaxis ==> Remove trigger → Epinephrine 0.3 mg IM (anterolateral thigh) → Call 911 → Lay flat/elevate legs → IV fluids wide open → Repeat epi q5–15 min PRN

6. Acute Chest Pain / STEMI ==> 12-lead ECG within 10 min → Aspirin 325 mg chew → Nitroglycerin SL → Morphine if refractory pain → Call 911 → Activate cath lab if ST elevation

7. Severe Hypoglycemia ==> Check glucose → If conscious: oral glucose/juice → If unconscious: D50 25 g IV push → Glucagon 1 mg IM if no IV → Recheck glucose q15 min

8. Status Epilepticus ==> Protect from injury → Time the seizure → Airway/O₂/suction → Lorazepam 4 mg IV (or midazolam 10 mg IM) → Call 911 → Check glucose → Repeat benzo x1 if seizing >5 min

9. Choking / Foreign Body Airway Obstruction ==> Conscious: encourage coughing → 5 back blows → 5 abdominal thrusts (Heimlich) → Repeat → If unconscious: lower to floor → Begin CPR → Look in mouth before ventilations

10. Severe Asthma / Respiratory Distress ==> Sit upright → O₂ to maintain SpO₂ >94% → Albuterol nebulizer back-to-back → Ipratropium → Methylprednisolone 125 mg IV → Call 911 if no improvement → Consider epinephrine IM

The H's and T's are the mnemonic used in ACLS to identify reversible causes of PEA (pulseless electrical activity) and asystole during cardiac arrest. 

The H's:

1. Hypovolemia — hemorrhage, dehydration, third-spacing

2. Hypoxia — airway obstruction, respiratory failure (most frequent cause of PEA at ~24%)  [2]

3. Hydrogen ion (Acidosis) — severe metabolic acidosis (e.g., DKA, renal failure, sepsis)

4. Hypokalemia / Hyperkalemia — electrolyte derangements

5. Hypothermia — environmental exposure, submersion

6. Hypoglycemia — sometimes included as a 6th H 

The T's:

1. Tension pneumothorax — needle decompression required

2. Tamponade (cardiac) — pericardiocentesis required

3. Toxins — drug overdose/poisoning (opioids, beta-blockers, CCBs, digoxin, TCAs)

4. Thrombosis, coronary — acute MI / STEMI

5. Thrombosis, pulmonary — massive pulmonary embolism

6. Trauma — sometimes included as a 6th T 

Clinical Pearls:

• Hypoxia (23.6%), acute coronary syndrome (12.5%), and trauma (12.5%) were the three most frequent identifiable causes of PEA in a large retrospective study; no cause was identified in 17.4% of cases.  [2]

• Bedside echocardiography during CPR can help rapidly differentiate causes such as tamponade, hypovolemia, PE, and true cardiac standstill, and is recommended by the Society of Critical Care Medicine. [1]

• The AHA 2025 ACLS guidelines emphasize that identifying and treating these reversible causes is the cornerstone of PEA/asystole management, as defibrillation is not indicated for non-shockable rhythms. 

1. VASOPRESSORS / HEMODYNAMIC SUPPORT

1. Epinephrine (1 mg/10 mL [1:10,000] for IV push; 1 mg/mL [1:1,000] for IM/anaphylaxis)

2. Norepinephrine (for refractory hypotension/shock)

3. Vasopressin (40 units IV for cardiac arrest; alternative vasopressor)

4. Dopamine (infusion for bradycardia with hypotension)

5. Dobutamine (inotropic support)

6. Phenylephrine (pure alpha-agonist for hypotension)

2. ANTIARRHYTHMICS

7. Amiodarone (300 mg IV for VF/pVT; rate control)

8. Lidocaine (alternative to amiodarone for VF/pVT)

9. Adenosine (6 mg/12 mg rapid IV push for SVT)

10. Procainamide (stable wide-complex tachycardia)

3. RATE / RHYTHM CONTROL — BETA-BLOCKERS

11. Metoprolol (IV for rate control, hypertensive emergency)

12. Labetalol (IV for hypertensive emergency)

13. Esmolol (short-acting IV beta-blocker for rate control)

4. RATE / RHYTHM CONTROL — CALCIUM CHANNEL BLOCKERS

14. Verapamil (IV for SVT, rate control of atrial fibrillation)

15. Diltiazem (IV for rate control of atrial fibrillation/flutter)

5. DIURETICS

16. Furosemide (Lasix) (20–40 mg IV for acute pulmonary edema)

6. ANTIHYPERTENSIVES / VASODILATORS

17. Nitroglycerin (sublingual tablets 0.4 mg; IV infusion for ACS/pulmonary edema)

18. Nitroprusside (hypertensive emergency, if stocked)

19. Hydralazine (IV for hypertensive urgency/pregnancy)

7. RESPIRATORY / BRONCHODILATORS

20. Oxygen (nasal cannula, non-rebreather mask, BVM)

21. Albuterol (nebulized or MDI for bronchospasm/asthma)

22. Ipratropium bromide (nebulized, adjunct for bronchospasm)

23. Racemic epinephrine (nebulized for stridor/croup)

8. METABOLIC / ELECTROLYTE AGENTS

24. Dextrose 50% (D50W) (25 g IV for hypoglycemia)

25. Dextrose 10% (D10W) (pediatric hypoglycemia)

26. Calcium chloride (10%, for hyperkalemia, calcium channel blocker toxicity)

27. Calcium gluconate (for hyperkalemia, hypocalcemia)

28. Sodium bicarbonate (8.4%, for hyperkalemia, sodium channel blocker toxicity, metabolic acidosis)

29. Magnesium sulfate (for torsades de pointes, eclampsia, severe asthma)

9. ANTICHOLINERGICS / VAGOLYTIC

30. Atropine (0.5 mg IV for symptomatic bradycardia; organophosphate poisoning)

10. ANTICOAGULANTS / ANTIPLATELETS

31. Aspirin (325 mg chewable for suspected ACS)

32. Heparin (unfractionated, if stocked for ACS protocols)

11. CORTICOSTEROIDS / ANTI-ALLERGY

33. Diphenhydramine (Benadryl) (25–50 mg IV/IM for allergic/anaphylactic reactions)

34. Dexamethasone (IV/IM for anaphylaxis, croup, airway edema)

35. Methylprednisolone (Solu-Medrol) (IV for severe allergic reactions, asthma)

12. ANALGESICS / SEDATIVES

36. Morphine (2–4 mg IV for pain, ACS adjunct)

37. Fentanyl (25–50 mcg IV for pain/procedural sedation)

38. Midazolam (Versed) (1–5 mg IV/IM/IN for seizures, sedation)

39. Diazepam (Valium) (5–10 mg IV/PR for seizures)

40. Lorazepam (Ativan) (1–2 mg IV for seizures, anxiety)

41. Ketamine (procedural sedation, refractory status epilepticus)

13. REVERSAL AGENTS / ANTIDOTES

42. Naloxone (Narcan) (0.4–2 mg IV/IM/IN for opioid reversal)

43. Flumazenil (0.2 mg IV for benzodiazepine reversal — use with caution)

44. Glucagon (1–2 mg IV/IM for hypoglycemia; beta-blocker/CCB toxicity)

14. ANTIEMETICS

45. Ondansetron (Zofran) (4 mg IV/ODT for nausea/vomiting)

15. IV FLUIDS & SOLUTIONS

46. Normal saline (0.9% NaCl) (volume resuscitation, drug dilution)

47. Lactated Ringer's solution (volume resuscitation)

48. D5W (drug infusion diluent)

Key Considerations for Clinic Code Carts:

• The AHA recommends that epinephrine, amiodarone, and lidocaine be immediately available for cardiac arrest management, with atropine for symptomatic bradycardia. 

• [1-3]

• The ACR recommends at minimum epinephrine IM, an inhaled beta-agonist, and an antihistamine for contrast reaction kits, with additional medications (atropine, nitroglycerin, furosemide, corticosteroids) as discretionary. 

• [4]

• The AAP lists epinephrine, albuterol, dexamethasone, naloxone, and oral dextrose as essential clinic medications, with midazolam, ceftriaxone, and ipratropium as additional options. 

• [5]

• All reversal agents (naloxone, flumazenil, glucagon) should be immediately available whenever opioids or benzodiazepines are administered. 

• [7]

• A periodic monitoring program to ensure medication shelf life and equipment functionality is recommended. 

• [4]

Below is a comprehensive outline of emergency airway equipment for a clinic code cart, organized by category and aligned with AHA, AAP, and ASA guidelines. 

[1-4]

1. OXYGEN DELIVERY DEVICES

• Oxygen source with flowmeter (wall-mounted or portable E-cylinder with regulator)

• Nasal cannula — infant, child, and adult sizes 

• [2]

• Simple oxygen masks — infant, child, and adult sizes

• Non-rebreather masks with reservoir bag — infant, child, and adult sizes 

• [1-2]

• Venturi masks (if precise FiO₂ titration needed)

2. BASIC AIRWAY ADJUNCTS

• Oropharyngeal airways (OPAs) — sizes 00 through 5 (infant through adult) 

• [1-2]

• Nasopharyngeal airways (NPAs) — sizes 12F through 30F (pediatric through adult) 

• [1-2]

• Tongue depressors 

• [5]

3. BAG-MASK VENTILATION (BVM)

• Self-inflating bag-mask devices — infant, child, and adult sizes 

• [1-2]

• Face masks to fit BVM adaptor — preterm, neonatal, infant, child, and adult sizes 

• [2]

• PEEP valve (attaches to BVM for positive end-expiratory pressure) 

• [6]

4. SUCTION EQUIPMENT

• Portable or wall-mounted mechanical suction unit 

• [1]

• Yankauer rigid suction tip (oropharyngeal suctioning) 

• [1][5]

• Flexible suction catheters — sizes 5F through 16F (for nasotracheal/ETT suctioning) 

• [1-2]

• Bulb syringe (neonatal/infant nasal suctioning) 

• [1]

• Suction tubing and connectors

5. SUPRAGLOTTIC AIRWAY DEVICES (SGAs) — Plan B

• Laryngeal mask airways (LMA) / i-Gel — sizes 1, 1.5, 2, 2.5, 3, 4, 5 

• [1-2]

  • SGAs are recommended as an easy-to-use alternative to endotracheal intubation, with higher success rates and greater skill retention in simulation studies compared with ETI 

  • [1]

  • The AHA states that either BVM or an advanced airway (SGA or ETI) may be considered during CPR 

  • [4]

6. ENDOTRACHEAL INTUBATION EQUIPMENT — Plan A

• Laryngoscope handle(s) (with extra batteries or rechargeable) 

• [2][5]

• Laryngoscope blades: 

• [2][5]

  • Straight (Miller): sizes 0, 1, 2, 3

  • Curved (Macintosh): sizes 2, 3, 4

• Endotracheal tubes (ETTs): 

• [2]

  • Uncuffed: 2.5, 3.0, 3.5 mm

  • Cuffed: 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0 mm

• Stylets — pediatric and adult sizes 

• [2-3]

• Bougie / intubating introducer (10F and 15F) — first-attempt success rate of 96% vs. 82% with stylets alone in difficult airways 

• [3][6]

• Magill forceps — pediatric and adult (for foreign body removal, nasal ETT placement) 

• [1-2][6]

• ETT securing devices (tape, commercial tube holders) 

• [5]

• Lubricant (water-soluble) 

• [5]

• Syringes (5 mL and 10 mL for cuff inflation) 

• [5]

• Cuff manometer 

• [5]

7. VIDEO LARYNGOSCOPY

• Video laryngoscope with appropriate blades (e.g., GlideScope, C-MAC) 

• [2-3][6]

  • Recommended as an additional consideration for difficult airway management by the ASA 

  • [3]

  • 
    

8. CONFIRMATION & MONITORING DEVICES

• End-tidal CO₂ detector (waveform capnography preferred; colorimetric as minimum) — 100% specificity for confirming ETT placement during cardiac arrest 

• [2][7]

• Pulse oximeter with neonatal, pediatric, and adult probes 

• [1-2]

• Stethoscope (for auscultation of bilateral breath sounds)

9. SURGICAL / EMERGENCY INVASIVE AIRWAY — Plan D (Can't Intubate, Can't Oxygenate)

• Cricothyrotomy kit (e.g., Cook-Melker Emergency Cricothyroidotomy Set — pediatric and adult) 

• [5-6]

• Scalpel (No. 10 or 20 blade)

• Tracheostomy tubes — sizes 3.5–5.5 mm (additional consideration) 

• [2]

10. NEBULIZATION EQUIPMENT

• Nebulizer with tubing and masks (infant, child, adult) 

• [1]

• Metered-dose inhaler (MDI) with spacer and mask

11. AIRWAY MANAGEMENT ADJUNCTS & ACCESSORIES

• Cervical collars — infant, child, and adult sizes (for suspected c-spine injury) 

• [2]

• Cardiac arrest board (rigid backboard for CPR) 

• [1-2]

• Gastric/orogastric tubes — 8F and 10F (for gastric decompression during BVM) 

• [2]

• Feeding tubes — 5F, 8F 

• [2]

12. COGNITIVE AIDS & SIZING TOOLS

• Color-coded length-based tape (e.g., Broselow tape) or preprinted weight-based drug/equipment dosing manual 

• [1-2]

• Laminated emergency airway algorithm (e.g., ASA Difficult Airway Algorithm, AHA ACLS algorithm) 

• [3][5]

• Preintubation checklist 

• [5]