■ Unresponsive state
1. Establish unresponsiveness with no respiration or pulse.
2. Deliver a precordial thump if cardiac arrest is witnessed and a defibrillator is not immediately available.
3. Begin CPR with high-flow oxygen.
4. Defibrillate at 200 J (or equivalent biphasic energy).
5. Defibrillate at 200-300 J (or equivalent biphasic energy).
6. Defibrillate at 360 J (or equivalent biphasic energy).
8. Administer epinephrine 1 mg (10 mL of 1:10,000) IVP (follow with 20 mL IV flush), repeat every 3-5 min; give 2.0-2.5 mg diluted in 10 mL normal saline if administering via ET tube; or administer a single dose of vasopressin 40 U IVP.
9. Defibrillate at 360 J (or equivalent biphasic energy) within 30-60 sec after each dose of medication. Pattern should be drug, shock; drug, shock. Consider the following antiarrhythmics for shock-refractory VF or VT:
10. Administer amiodarone 300 mg (diluted in 20-30 mL D5W) IVP; or lidocaine 1.0-1.5 mg/kg IVP, 2-4 mg/kg by ET tube.
11. Repeat initial antiarrhythmic for shock-refractory VF or VT: amiodarone 150 mg IVP; or lidocaine 0.5-0.75 mg/kg IVP, repeat lidocaine every 5-10 min, max. 3 mg/kg.
12. Administer magnesium sulfate 1-2 g (2-4 mL of a 50% solution) diluted in 10 mL of D5W IVP in polymorphic VT, torsade de pointes, or suspected hypomagnesemia.
13. If no response, consider procainamide 30-50 mg/min IV infusion, max. 17 mg/kg; or sodium bicarbonate 1 mEq/kg IVP, may repeat 0.5 mEq/kg every 10 min.
V Clinical Tip: Do not delay defibrillation.
V Clinical Tip: If vasopressin is used, wait 10-20 min before administering epinephrine.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...