ADULT

• Respiratory management
  • Place NP/OP, use BVM and non-rebreather mask
• AED
  • Defibrillate immediately if shock advixed, resume CPR immediately after shock
• Consider supraglottic device after 3 cycles of CPR; Minimize interruption of chest compressions

• IV/IO access
• Epinephrine: 1 mg IV/IO push, repeat q 3-5 minutes prn pulselessness LR at 500 ml/hr
• Defibrillation at 200J biphasic if indicated

• Pulseless VT/VF
  • Amiodarone 300 mg IV/IO
  • Amiodarone 150 mg if needed
• Consider 12 lead EKG
• Unstable Tachycardia with pulse:
  • ◦ Signs of instability
    • Hypotension
    • Shock
    • Altered mental status
    • Chest pain
    • Pulmonary edema
• Synchronized cardioversion
  • Consider sedation
    • Versed 2-5 mg IV/IO appropriate monitoring required
  • 120-200 J Biphasic
• Adenosineif narrow complex
  • 6 mg IV/IO rapid push
  • 12 mg IV/IO rapid push if needed
• Stable wide complex tachycardia
  • Amiodarone 150 mg IV/IO over 10 minutes
• Bradycardia
  • Symptomatic
    • hypotension
    • altered mental status
    • ischemic chest pain
    • acute pulmonary edema
  • Atropine 0.5-1 mg IV/IO every 3-5 minutes as needed max dose of 3 mg
  • Consider transthoracic cardiac pacing

Pediatric (not to exceed adult dose)

• Respiratory management
  • Place NP/OP, BVM at 1 breath q 4-6 seconds
• AED
  • Defibrillate immediately if shock advised, resume CPR immediately after shock

• BVM, consider supraglottic airway
• IV/IO access
• Epinephrine: 0.1 ml/kg (1:10,000) IV/IO push, repeat every 3-5 minutes prn pulselessness
• LR 20 ml/kg bolus
• Defibrillation at 2 J/kg first shock, 4 J/kg subsequent shocks

• Pulseless VT/VF
  • Amiodarone 5 mg/kg, repeat times 2 if needed
• Bradycardia
  • Cardiopulmonary compromise
    • hypotension
    • altered mental status
    • signs of shock
  • Atropine 0.02 mg/kg IO/IV
    • may repeat once
    • min dose: 0.1 mg
    • max dose: 0.5 mg
  • Consider transthoracic cardiac pacing