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Medical Decision Flow
Unresponsive - Not Breathing or Gasping
High-Quality CPR
- Push hard (at least 2 inches [5 cm]) and fast (100–120/min) and allow complete chest recoil.
- Minimize interruptions in compressions.
- Avoid excessive ventilation.
- Change compressor every 2 minutes, or sooner if fatigued.
- If no advanced airway, 30:2 compression-ventilation ratio.
- Quantitative waveform capnography
Start CPR (30 compressions : 2 breaths)
AED Arrives - Attach Pads - Analyze Rhythm
Continue until AED analyzes or signs of recovery occur.
Not Shockable
Resume CPR immediately for 2 minutes
Shock Energy for Defibrillation
- Biphasic: Manufacturer recommendation (eg, initial dose of 120–200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered.
- Monophasic: 360 J
Drug Therapy
- Epinephrine IV/IO dose: 1 mg every 3–5 minutes
- Amiodarone IV/IO dose: First dose: 300 mg bolus. Second dose: 150 mg. OR Lidocaine IV/IO dose: First dose: 1–1.5 mg/kg. Second dose: 0.5–0.75 mg/kg.
Advanced Airway
- Endotracheal intubation or supraglottic advanced airway
- Waveform capnography or capnometry to confirm and monitor ET tube placement
- Once advanced airway in place, give 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions
Reversible Causes
- Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/hyperkalemia, Hypothermia
- Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary/coronary)
Shockable Rhythm
Deliver 1 Shock - Resume CPR immediately
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