ACLS Cardiac Rhythm Recognition & Management Cheat Sheet

ACLS Cardiac Rhythm Recognition & Management — Cheat Sheet

W.G.M. Rivero MD · FPCP · DPSN · · williamriveromd.com · 2026

ACLS Rhythm Recognition & Management — Supraventricular

Sinus & atrial rhythms · recognize, then treat

Renal Care Unit · clinician reference

Sinus & Atrial

Rhythm & recognition	ECG strip		Management
Normal Sinus RhythmP before every QRS; regular; 60–100			No treatment — baseline rhythm.
Sinus BradycardiaRegular, rate < 60			If symptomatic: atropine 1 mg (max 3 mg); pacing, dopamine or epinephrine. Treat cause.
Sinus TachycardiaRegular, rate > 100			Treat the underlying cause (pain, fever, hypovolemia, hypoxia, anxiety).
Sinus ArrhythmiaRate varies with respiration			Benign — no treatment.
Premature Atrial ComplexEarly P, abnormal morphology			Usually benign; cut stimulants/caffeine; treat cause.
Atrial TachycardiaFast, abnormal P-wave axis			Vagal/adenosine; rate control (β-blocker or CCB); treat cause.
Multifocal Atrial Tachy≥3 P morphologies; irregular			Correct K⁺/Mg²⁺; treat lung disease; CCB if needed (avoid β-blocker in COPD).
SVT (AVNRT)Narrow, regular, ~150–250; no P		PERI-ARREST	Vagal → adenosine 6→12 mg; β-blocker/CCB; cardiovert if unstable.
Atrial FlutterSaw-tooth flutter waves			Rate control (β-blocker/CCB) + anticoagulation; cardiovert if unstable; ablation.
Atrial FibrillationIrregularly irregular; no P			Rate control + anticoagulation (weigh bleeding in HD); cardiovert if unstable.

SHOCKABLE VF · pulseless VT NON-SHOCK asystole · PEA PERI-ARREST unstable — treat per algorithm. Strips are schematic single-lead illustrations for pattern recognition; doses are usual adult values — verify locally.

Schematic ECG reference for trained personnel — for pattern recognition, not diagnosis. Correlate with the patient, a 12-lead ECG, and the responding physician’s judgment. Verify all doses against your local protocols; in dialysis, suspect hyperkalemia early.

williamriveromd.com
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ACLS Rhythm Recognition & Management — Junctional, Blocks & Special

AV conduction · paced, pre-excitation & the dialysis hyperkalemia ECG

Renal Care Unit · clinician reference

Junctional & AV Blocks

Rhythm & recognition	ECG strip		Management
Junctional EscapeNo/inverted P; 40–60			Treat cause; atropine if symptomatic; do not suppress the escape rhythm.
1st-degree AV BlockConstant long PR (>0.20 s)			Usually none; review AV-nodal blocking drugs.
2nd-deg Mobitz I (Wenckebach)PR lengthens, then dropped beat			Observe; atropine if symptomatic; stop offending drugs.
2nd-deg Mobitz IIConstant PR; sudden dropped QRS		PERI-ARREST	Pacing (usually permanent); atropine often ineffective; avoid AV-nodal blockers.
3rd-degree (Complete)P and QRS independent		PERI-ARREST	Transcutaneous → transvenous pacing → permanent pacemaker; atropine usually ineffective.

Paced & Special

Rhythm & recognition	ECG strip		Management
Paced RhythmPacer spike before each complex			Verify capture/sensing; magnet if malfunction; treat the underlying rhythm.
WPW / Pre-excitationShort PR; delta wave			Avoid AV-nodal blockers in pre-excited AF; procainamide; cardiovert if unstable; ablation.
Hyperkalemia (dialysis)Peaked T → wide QRS → sine wave		PERI-ARREST	Calcium gluconate 1–2 g → insulin+D50, salbutamol, ±bicarb → EMERGENCY DIALYSIS (low-K bath).

SHOCKABLE VF · pulseless VT NON-SHOCK asystole · PEA PERI-ARREST unstable — treat per algorithm. Strips are schematic single-lead illustrations for pattern recognition; doses are usual adult values — verify locally.

Schematic ECG reference for trained personnel — for pattern recognition, not diagnosis. Correlate with the patient, a 12-lead ECG, and the responding physician’s judgment. Verify all doses against your local protocols; in dialysis, suspect hyperkalemia early.

williamriveromd.com
Page 2 of 3 · /guides/code-blue-acls-dialysis-unit.html

ACLS Rhythm Recognition & Management — Ventricular & Arrest

Shockable vs non-shockable · the code rhythms

Renal Care Unit · clinician reference

Ventricular & Arrest

Rhythm & recognition	ECG strip		Management
Premature Ventricular ComplexEarly, wide, bizarre QRS			Usually none; correct K⁺/Mg²⁺ & ischemia; treat if frequent/symptomatic.
Accel. Idioventricular (AIVR)Wide, regular, 40–120; no P			Often benign (reperfusion) — observe; treat only if poorly tolerated.
Idioventricular / AgonalSlow, wide, dying rhythm			CPR + ACLS; treat reversible causes — usually a peri-arrest/agonal rhythm.
Monomorphic VTWide, regular, fast		SHOCKABLE	With pulse — stable: amiodarone/procainamide; unstable: synchronized cardioversion.
Torsades de PointesPolymorphic; twists around baseline		SHOCKABLE	Magnesium 1–2 g IV; stop QT drugs; correct K⁺/Mg²⁺; pacing; defibrillate if pulseless.
Ventricular FibrillationChaotic; no organized complexes		SHOCKABLE	DEFIBRILLATE + CPR; epinephrine 1 mg q3–5 min; amiodarone 300→150 mg.
Pulseless VTWide regular VT, NO pulse		SHOCKABLE	Treat as VF — DEFIBRILLATE + CPR; epinephrine; amiodarone.
AsystoleFlat line; confirm in 2 leads		NON-SHOCK	CPR + epinephrine 1 mg q3–5 min; NOT shockable; treat H's & T's (esp. K⁺).
PEAOrganized rhythm, NO pulse		NON-SHOCK	CPR + epinephrine; NOT shockable; find & treat the cause (H's & T's).

SHOCKABLE VF · pulseless VT NON-SHOCK asystole · PEA PERI-ARREST unstable — treat per algorithm. Strips are schematic single-lead illustrations for pattern recognition; doses are usual adult values — verify locally.

Schematic ECG reference for trained personnel — for pattern recognition, not diagnosis. Correlate with the patient, a 12-lead ECG, and the responding physician’s judgment. Verify all doses against your local protocols; in dialysis, suspect hyperkalemia early.

williamriveromd.com
Page 3 of 3 · /guides/code-blue-acls-dialysis-unit.html