ALS: Disease Progression and Supportive Care

The clinician leads advanced life support following current resuscitation guidelines. The cardiac arrest algorithm begins with high-quality CPR (rate 100-120 compressions per minute, depth 5-6 cm, full chest recoil, minimal interruptions) and rapid rhythm identification. Shockable rhythms: ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) -- immediate defibrillation with biphasic device at manufacturer-recommended energy (typically 120-200 J initial, maximum energy for subsequent shocks), followed by immediate resumption of CPR for 2 minutes before rhythm recheck. Epinephrine 1 mg IV/IO every 3-5 minutes (after the second shock for VF/pVT; as soon as possible for non-shockable rhythms). Amiodarone 300 mg IV bolus after the third shock for refractory VF/pVT, then 150 mg if VF/pVT persists. Non-shockable rhythms: asystole and pulseless electrical activity (PEA) -- CPR, epinephrine, and treatment of reversible causes (H's and T's: Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/hyperkalemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary, Thrombosis coronary). The clinician manages the post-cardiac arrest care: targeted temperature management (32-36 degrees Celsius for 24 hours for comatose survivors), coronary angiography for suspected cardiac etiology, hemodynamic optimization (MAP greater than or equal to 65...