- Initial Actions:
- Open airway
- Give breath
- Start CPR
- 100% O2 by BVM (initially)
- Code cart
- Place cardioversion/defibrillation pads
- Establish IV
- Monitors (Rhythm, Oximetry, BP)
- Obtain 12 lead EKG
- Secondary Actions:
- Defibrillation, unsynchronized at 360J (monophasic) or 120-200J (biphasic). Resume CPR immediately.
- 5 Cycles of High Quality CPR (each cycle is 30 compressions then 2 breaths via BVM). CPR to continue uninterrupted until resuscitation successful.
- Once IV is established, administer epinephrine or vasopressin [dosing below].
Epinephrine Dosing
1 mg IVP or 2-2.5 mg ETT administered every 3-5 minutes until efforts cease or are successful (IV preferred).
Vasopressin Dosing
40 units IVP (may replace either 1st or 2nd dose of epinephrine with vasopressin if desired). If vasopressin used, next dose of epinephrine is 10 minutes after vasopressin. - Establish advanced airway
- After EVERY 5 cycles of CPR, check rhythm and confirm no pulse, then defibrillate. Following defibrillation, immediately resume CPR for an additional 5 cycles before assessing rhythm and pulse.
- As early as possible, administer appropriate anti-arrhythmic agent (Amiodarone favored, lidocaine acceptable):
- Amiodarone dosing:300 mg IVP, then in 3-5 minutes may add 150 mg IVP, then 1 mg/minute infusion × 6 hours then 0.5 mg/minute × 18 hours.
- Lidocaine dosing:1-1.5 mg/kg initially, then 0.5-0.75 mg/kg every 5-10 minutes if needed [Max cumulative dose is 3 mg/kg]. After bolus establish infusion of 1-4 mg/min (30-50 mcg/kg/min).
- Consider reversible causes:
- Hypovolemia such as severe dehydration or massive hemorrhage
- Hypoxia
- Myocardial Infarction or Pulmonary Embolus
- Trauma such as tension pneumothorax, tamponade, aortic rupture
- Poisoning such as beta blockers, TCA's, Digoxin
- Metabolic causes such as hyperkalemia, hypokalemia, acidosis
- Hypothermia
- Cardiac Tamponade
- Myocardial Infarction or Pulmonary Embolus
Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.