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A
A
B
B
C
C
D
D
Assess rhythm
Assess rhythm
VF/VT
VF/VT
Attempt
Attempt
defibrillation x 1
defibrillation x 1
as necessary
as necessary
CPR
CPR
1-2 minutes
1-2 minutes
Non-VF/VT
Non-VF/VT
CPR
CPR
1-2 minutes
1-2 minutes
1 April 2011
Assess Rhythm
Pulseless VF / VT
PEA
Go to Fig 3
Asystole
Go to Fig 4
Adrenaline 1 mg IV push
CPR
Defibrillate within 1 min
CPR
Adrenaline 1 mg IV push
CPR
Defibrillate within 1 min
CPR
Lignocaine 50-100mg IV push
CPR
CPR
Defibrillate within 1 min
CPR
CPR
If rhythm is VF,
continue with VF
algorithm
If VF is converted,
follow algorithm for
ROSC, PEA or
Asystole.
Mg SO4 1-2 g IV
if polymorphic
VT/ Torsades
Continue CPR
Give appropriate medication as indicated
Defibrillate 360 J monophasic or 150-200 J biphasic within 1 min
after each dose of medication. For subsequent shocks for
biphasic, can escalate energy level gradually up to a max of 360 J
Pattern should be CPR-drug-shock, CPR-drug shock
1 April 2011
Note :
CPR must be continued at all times & also when drugs
are given
Stop CPR briefly only for analyzing rhythm
If IV access is unavailable, do not delay shock.
Continue CPR-drug-shock
Assess rhythm
Assess rhythm
Adrenaline 1 mg IV push,
Adrenaline 1 mg IV push,
repeat every 3 to 5 minutes.
repeat every 3 to 5 minutes.
1 April 2011
Assess rhythm
Assess rhythm
Asystole
Asystole
Adrenaline 1 mg IV push,
Adrenaline 1 mg IV push,
repeat every 3 to 5 minutes.
repeat every 3 to 5 minutes.
1 April 2011
Assess rhythm
Assess rhythm
Bradycardia
Bradycardia
Slow (absolute bradycardia = rate<60 bpm
Slow (absolute bradycardia = rate<60 bpm
or
or
Relatively slow (rate less than expected
Relatively slow (rate less than expected
relative to underlying condition or cause)
relative to underlying condition or cause)
No
Observe
Observe
23 August 2011
Yes
Intervention sequence
Intervention sequence
Atropine 0.6 mg a a
Atropine 0.6 mg
Transcutaneous pacing if available
Transcutaneous pacing if available
Dopamine 2 to 20 mcg/kg per min
Dopamine 2 to 20 mcg/kg per min
Adrenaline 2 to 10 mcg/min Infusion
Adrenaline 2 to 10 mcg/min Infusion
Yes
ECG monitor
ECG monitor
Assess vital signs
Assess vital signs
Review history
Review history
Perform physical examination
Perform physical examination
Do 12 Lead ECG
Do 12 Lead ECG
Yes
Immediate synchronised
Immediate synchronised
Cardioversion
Cardioversion
No
Narrow Complex
Narrow Complex
Tachycardia
Tachycardia
Atrial
Atrial
fibrillation
fibrillation
Atrial flutter
Atrial flutter
Wide Complex
Wide Complex
Tachycardia
Tachycardia
Paroxysmal
Paroxysmal
supraventricular
supraventricular
tachycardia (PSVT)
tachycardia (PSVT)
If strongly
suspect
aberrancy
If suspect VT or
uncertain WCT
Adenosine 6mg
Adenosine
rapid
iv push 6mg
rapid iv push
Lignocaine
Lignocaine
50-100
mg
IV50-100
push mg
IV push
Amiodarone
Amiodarone
150
mg IV
150 over
mg IV
push
10push
minsover
10 mins
Lignocaine
Lignocaine
50-100
mg
IV50-100
push mg
IV push
Amiodarone
Amiodarone
150
mg IV
15010
mg IV
over
over
mins 10
mins
Vagal maneuvers
Vagal maneuvers
* Adenosine 6 mg
* Adenosine
rapid
IV push 6 mg
rapid IV push
Adenosine 12mg
Adenosine
rapid
iv push 12mg
rapid iv push
* Verapamil 1 mg
* Verapamil
1 mg
/ min
(up to max
20/ min
mg) (up to max
20 mg)
If still VT,
If still VT,
synchronised
synchronised
cardioversion
cardioversion
Adenosine
Adenosine
12mg
rapid iv push
12mg rapid iv push
What
* either drug depending on
availability and experience
1 April 2011
Polymorphic VT
Polymorphic VT
Correct abnormal
Correct abnormal
electrolytes
electrolytes
Treat
ischemia if present
Treat ischemia if present
Medications:
Medications:
Magnesium
Magnesium
Consider
overdrive
Consider
overdrive
pacing
if bradycardia
pacing if bradycardia
related
related