Pulseless Arrest

Pulseless Arrest
■ BLS algorithm, call for help, begin CPR if indicated. ■ Administer oxygen and attach monitor/defibrillator. ■ Search for and manage reversible causes (see below).
V-Fib/Pulseless VT	Asystole/PEA
Shock: Biphasic, 200 J; or monophasic, 360 J. CPR: Immediately resume 5 cycles of CPR (2 min). Vasopressor (given without interrupting CPR): ■ Epinephrine 1 mg IV or IO (2–2.5 mg ET) every 3–5 min. or ■ Vasopressin 40 units IV or IO, one time only. May use to replace 1st or 2nd dose of epinephrine. Shock: Biphasic, 200 J; or monophasic, 360 J. Consider antiarrhythmics (given without interrupting CPR): ■ Amiodarone 300 mg IV or IO, repeat 150 mg in 3–5 min. ■ Lidocaine 1.0–1.5 mg/kg IV or IO, repeat 0.5–0.75 mg/kg every 5–10 min, max 3 mg/kg. ■ Magnesium 1–2 g IV or IO for torsade de pointes.	CPR: Resume CPR for five cycles (~2 min). Vasopressor (given without interrupting CPR): ■ Epinephrine 1 mg IV or IO (2–2.5 mg ET) every 3–5 min. or ■ Vasopressin 40 units IV or IO, one time only. May use to replace 1st or 2nd dose of epinephrine. CPR: Immediately resume 5 cycles of CPR (2 min) ■ Atropine 1 mg IV (2–3 ET) every 3–5 min (max 3 mg) for asystole or PEA <60. Search for Reversible Causes ■ Hypovolemia ■ Hypoxia ■ Hydrogen ion (acidosis) ■ Hypokalemia ■ Hyperkalemia ■ Hypoglycemia ■ Hypothermia ■ Toxins ■ Tamponade (cardiac) ■ Tension pneumothorax ■ Thrombosis (coronary, PE) ■ Trauma