• Assess responsiveness
• Active EMS
• Call for defibrillator
• Head tilt, chin left, look, listen & feel for breathing
• Give 2 breaths
• Look for signs of circulation including a pulse
• No pulse, start CPR at a rate of 15:2
• Attach monitor with Quick combo patches
• Identify rhythm as V fib or pulseless VT
• Charge to 200 j., clear the table and deliver the shock
• Reassess rhythm as v fib
• Charge to 300j., clear the table and deliver the shock
• Reassess rhythm as v fib
• Charge to 360j., clear the table and deliver the shock
• Continue CPR
• Intubate and confirm with 5 point auscultation & end CO2 detector (if available)
• Start IV in antecubital with large angio cath
• Attach monitor leads
• Epinephrine 1mg. IV push, repeat every 3-5 min. (May use Vasopressin 40 Units IV once instead of Epinephrine. Must wait 10 minutes before giving Epinephrine.)
• Check pulse. Contiue CPR
• Defribillate 360 J within 30-60 seconds
• Check pulse. Continue CPR
• Lidocaine 1.0-1.5 mg/kg IV push, Consider repeat dose of 0.5-0.75mg/kg every 5-10 min to a maximum dose of 3 mg/kg. (May choose to use Amiodarone instead of Lidocaine. Amiodarone dose is 300mg IVP. May use a repeat dose of 150mg in 5-10min.)
• Check pulse, continue CPR
• Defibrillate 360 J
• Check pulse, continue CPR
• Consider Magnesium sulfate 1-2 g IV in torsades de pointes or known hypomagnesic state of refractory VF
  
• Sodium bicarbonate mmEq/kg IV for acidosis or tricyclic antidepressant overdose. Ventilate patient well.
  

To: ACLS Intravenous Medicated Infusions