UST Life Support Training Center Pulseless Arrest

Pulseless arrest algorithm 2010 recommendation Patient is unresponsive no chest movement (Call for help) no pulse Do BLS (attach monitor and secure venous access)

VF/VT

Asystole/PEA

No drug

Epi 1 mg

Epi 1mg

Amio 300

Epi 1 mg

Shock 360 joules (monophasic)

5 cycles of CPR

Stop Analyze Switch roles

Confronted with a patient who is unresponsive, with no chest movement, (call for help) and pulseless, initiate BLS Once team arrives, assign team members to resume CPR, attached patient to monitor, insert IV line and record the code. Once monitor is ready, identify the rhythm 1. if rhythm is shockable (Ventricular VIFrillation/Ventricular TACHycardia) a. immediately deliver a shock at 360 joules for monophasic defibrillator. (For biphasic defibrillator, the energy depends on the manufacturers recommendation). This is followed by five cycles of CPR. No drug is given at this time. b. After 2 minutes, stop, analyze the rhythm and switch roles (S.A.S.) *Note, it is the chest compressor and the electrical therapist who will switch role. c. If rhythm persists, deliver another shock at 360 joules, followed by five cycles of CPR. During CPR, give epinephrine 1mg, 1:10,000 dilution followed by 20 cc NSS flush and elevating the arm. d. After 2 minutes, stop, analyze the rhythm and switch roles (S.A.S.) *Note, it is the chest compressor and the electrical therapist who will switch role. e. If rhythm persists, deliver another shock at 360 joules, followed by five cycles of CPR. During CPR, give amiodarone 300 mg followed by 20 cc NSS flush and elevating the arm. 2. if rhythm is non-shockable (Asystole/ PEA) a. Immediately initiate five cycles of CPR. During CPR, give epinephrine 1mg, 1:10,000 dilution followed by 20 cc NSS flush and elevating the arm. b. After 2 minutes, stop, analyze the rhythm and switch roles (S.A.S.) *Note, it is the chest compressor and the electrical therapist who will switch role. c. If rhythm persists, deliver five cycles of CPR. No drug is given during this time. (Epinephrine is give every 3 to 5 minutes). d. After 2 minutes, stop, analyze the rhythm and switch roles (S.A.S.) *Note, it is the chest compressor and the electrical therapist who will switch role. e. If rhythm persists, deliver five cycles of CPR. May give second dose of epinephrine 1mg, 1:10,000 dilution followed by 20 cc NSS flush and elevating the arm. (This is already 4 minutes from the first dose of epinephrine). f. If epinephrine is not available, may give vasopressin 40 units. In contrast to epinephrine, vasopressin is good for 20 minutes.