<Go to node 4>

Continue CPR while charging defibrillator.
Give 1 shock (biphasic: same as first shock or higher dose; monophasic: 360 joules).
Immediately resume CPR.
Epinephrine 1 mg I.V. or I.O. Repeat every 3 to 5 min OR give 1 dose of vasopressin 40 units I.V. or I.O. to replace first or second dose of epinephrine.

End

Check rhythm. Shockable rhythm?

VF/VT

• Give 1 shock (biphasic: 120 to 20 joules; monophasic: 360 joules).
• Immediately resume CPR.

Check rhythm. Shockable rhythm?

Check rhythm. Shockable rhythm?

Continue CPR while charging defibrillator.
Give 1 shock (biphasic: same as first shock or higher dose; monophasic: 360 joules).
Immediately resume CPR.
Consider antiarrhythmics; give during CPR.
Consider magnesium, loading dose.
After 5 cycles of CPR*, check rhythm and follow pathway as mentioned above.

Asystole/PEA

Immediately resume CPR for 5 cycles.
Give epinephrine 1 mg I.V. or I.O. Repeat every 3 to 5 min OR give 1 dose of vasopressin 40 units I.V. or I.O. to replace first or second dose of epinephrine.
Consider atropine 1 mg I.V. or I.O. for asystole or slow PEA rate. Repeat every 3 to 5 min (up to 3 doses).

• If asystole, go to box 10.

• If electrical activity, check pulse. If no pulse, go to box 10.

• If pulse present, begin postresuscitation care.

Go to box 4.

*After an advanced airway is placed, give continuous chest compressions without pauses for breaths.

Give 5 cycles of CPR*

Give 5 cycles of CPR*

Check rhythm. Shockable rhythm?

Yes