Check the cardiac rhythm.
Check for a pulse.
Figure 3-6. Normal cardiac rhythm.
(7) If the rhythm is adequate, check the carotid pulse to see if the pulse is
associated with the rhythm shown on the oscilloscope. Also, check the vital signs and
remain with the patient until he is evacuated.
d. If ventricular fibrillation continues, give a third countershock at 360 joules
e. If there is no pulse, this countershock has not been successful. Resume
f. Establish an effective airway. (Endotracheal intubation is preferable.)
g. Establish an intravenous (IV) line. (Two lines are preferable.)
h. Administer drug therapy as clinically indicated. Epinephrine (adrenalin) in a
1:10,000 solution in the dosage 0.5 to 1 mg may be injected intravenously and repeated
at five minute intervals, if necessary. Give endotracheally if an IV line cannot be
i. If ventricular fibrillation still continues, administer the third countershock. Use
an energy load of not more than 360 joules. Stop CPR before the countershock and
resume CPR after the countershock, if necessary.
j. Administer other drug therapy as clinically indicated. Include lidocaine
(Xylocaine ) 50 to 100 mg IV push.
CAUTION: Do not exceed 225 mgs of lidocaine.) Also, include bretylium tosylate
(Bretylol) in the dosage 5 mg/kg IV bolus if lidocaine is ineffective.