every 2 mins?

non shockable?

shockable 2

every two minutes: rhythm check, shock if shockable, pulse check if an organized rhythm is found, change compressors, administer drug therapy

non-shockable rhythms PEA/acystole: vasopressors (epinephrine)

shockable rhythms VF/pulseless VT: vasopressors and antiarrhythmics (amiodarone)

epinephrine: potent alpha-adrenergic agonist, but increases cardiac oxygen demand through the beta-adrenergic effect
- 1mg dose IV/IO every 3-5 minutes, followed by 20 cc of saline
- increases chance of ROSC, but does not improve survival

amiodarone: effects sodium, potassium, calcium channels, adrenergic receptors; class III antiarrhythmic
- initial dose of 300 mg, followed by 1 dose of 150 mg IV/IO
- use dextrose or pure water to fill dose to 20mL
- only increases rate of hospital admission, not survival

Defibrillation: 120-200 for biphasic waveform, 360 for monophasic

·         Waveform capnography

·         Waveform capnography

o   If EtCO2<10 – improve chest compressions

o   - If EtCO2 remains low – chances of ROSC very low

circulation

goal?

if needed? 4

circulation: maintain SBP > 90mmHg, get a 12-lead ECG, consider treatable causes, draw blood, CXT, treat arrhythmias
- if needed: fluid blous of 1-2L, vasopressor support, dopamine (5-10µg/kg/min) or nor/epinephrine (0.1-0.5µg/kg/min)