m. If there is electromechanical dissociation (organized electrical activity without
myocardial contraction) when the patient's cardiac rhythm is NOT correlated with his
pulse, use these procedures:
(1) Administer CPR with optimal ventilation. Open the airway and blow into
the patient's mouth to begin the process of restoring breathing and heartbeat.
(2) Administer epinephrine. The recommended dosage is 0.5 mg to 1.0 mg
(5 to 10 ml of a 1:10,000 solution) given intravenously. Repeat every five minutes
during resuscitative efforts. DO NOT administer epinephrine in the same intravenous
line as alkaline solutions such as sodium bicarbonate.
n. If electromechanical dissociation persists, give additional doses of
epinephrine at time intervals and as clinical judgment dictates.
Previously, sodium bicarbonate was recommended in the treatment of cardiac
arrest. Currently, there is controversy over this drug's benefit. Therefore, use
sodium bicarbonate only after you have tried therapies such as defibrillation,
cardiac compression, intubation, epinephrine, and antiarrhythmics have been
tried without success.
o. The causes of electromechanical dissociation must be considered.
Correctable causes include hypovolemia, cardiac tamponade, tension pneumothorax,
hypoxemia, and acidosis. Less correctable cause of EMD include massive myocardial
damage from miocardial infarction, prolonged ischemia during resuscitation, and
SECTION IV. CARDIOVERSION
3-13. ATTACH THE PATIENT TO THE CARDIAC MONITOR
Follow this procedure:
a. Rub the electrode site with an alcohol pad to remove oil and dead tissue from
the surface. (Shave hair if necessary.)
b. Apply conductive paste or gel to the electrodes and attach the electrodes to
Never use alcohol on electrodes. Alcohol could ignite and burn the