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Advanced Cardiac Life Support (ACLS) rhythm recognition is a fundamental competency for clinicians managing cardiac arrest, peri-arrest states, and hemodynamic instability. Rapid, accurate identification of life-threatening arrhythmias directly determines treatment priority and patient survival.
Cardiac rhythms reflect the organized or disorganized propagation of electrical impulses through the conduction system. Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are shockable rhythms with depolarization originating from chaotic ventricular foci. Pulseless electrical activity (PEA) and asystole are non-shockable and require identification of reversible causes (the Hs and Ts).
ACLS clinical reasoning centers on two questions: Does the patient have a pulse? Is the rhythm shockable? For unstable patients with a pulse, the decision tree branches based on rate (tachycardia vs. bradycardia), QRS width, and hemodynamic stability. The 5H5T framework guides treatment of PEA: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (pulmonary and coronary).