1
PULSELESS ARREST
• BLS Algorithm: Call for help, give CPR
• Give oxygen when available
• Attach monitor/defibrillator when available
2
Shockable
3
VF/VT
4
Give 1 shock
• Manual biphasic: device specific
(typically 120 to 200 J)
Note: If unknown, use 200 J
• AED: device specific
• Monophasic: 360 J
Resume CPR immediately
Check rhythm
Shockable rhythm?
12
Not Shockable
9
AsystoWPEA
10
Resume CPR immediately for 5 cycles
When IV/IO available, give vasopressor
• Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min
• May give 1 dose of vasopressin 40 IJ IV/IO to
replace first or second dose of epinephrine
Consider atropine 1 mg IV/IO
for asystole or slow PEA rate
Repeat every 3 to 5 min (up to 3 doses)
Give 5 cycles
of CPR*
Check rhythm
Shockable rhythm?
5
Give 5 cycles of CPR*
Check rhythm
Shockable rhythm?
Shockable
6
Continue CPR while defibrillator is charging
Give I shock
• Manual biphasic: device specific
(same as first shock or higher dose)
Note: If unknown, use 200 J
• AED: device specific
• Monophasic: 360 J
Resume CPR immediately after the shock
When IV/IO available, give vasopressor during CPR
(before or after the shock)
• Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min
• May give 1 dose of vasopressin 40 U IV/IO to
replace first or second dose of epinephrine
13
GO to
Box 4
Not
Shockable
During CPR
Shockable
7
Give 5 cycles Of CPR*
• If asystole, go to Box 10
• If electrical activity, check
pulse. If no pulse, go to
Box 10
• If pulse present, begin
postresuscitation care
Check rhythm
Shockable rhythm?
Shockable
8
No
Continue CPR while defibrillator is charging
Give 1 shock
• Manual biphasic: device specific
(same as first shock or higher dose)
Note: If unknown, use 200 J
• AED: device specific
• Monophasic: 360 J
Resume CPR immediately after the shock
Consider antiarrhythmics; give during CPR
(before or after the shock)
amiodarone (300 mg IV/IO once, then
consider additional 150 mg IV/IO once) or
lidocaine (1 to 1.5 mg/kg first dose, then 0.5 to
0.75 mg/kg IV/IO, maximum 3 doses or 3 mg/kg)
Consider magnesium, loading dose
I to 2 g IV/IO for torsades de pointes
After 5 cycles of CPR,' got to Box 5 above
• Push hard and fast (100/min)
• Ensure full chest recoil
• Minimize interruptions in chest
compress' ons
• One cycle of CPR: 30 compressions
then 2 breaths; 5 cycles 22 min
• Avoid hyperventilation
• Secure airway and confirm placement
* After an advanced airway is placed,
rescuers no longer deliver "cycles"
of CPR. Give continous chest com-
pressions without pauses for breaths.
Give 8 to 10 breaths/minute. Check
rhythm every 2 minutes
• Rotate compressors every
2 minutes with rhythm checks
• Search for and treat possible
contributing factors:
— Hypovolemia
— Hypoxia
— Hydrogen ion (acidosis)
— Hypo-/hyperkalemia
— Hypoglycemia
— Hypothermia
— Toxins
— Tamponade, cardiac
— Tension pneumothorax
— Thrombosis (coronary or
pulmonary)
— Trauma
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