(2) Treatment. For a witnessed arrest, first check the patient for a pulse. I
there is no pulse, perform a precordial thump. Again check for a pulse; if there is no
pulse, perform CPR until a defibrillator is available. For an unwitnessed arrest, check
for a pulse. If there is no pulse, perform CPR until a defibrillator is available. Follow this
procedure for either a witnessed arrest or an unwitnessed arrest once a monitor is
available:
(a) Check the monitor for rhythm.
(b) Defibrillate at 200 joules. Check the pulse and rhythm.
(c) If this is unsuccessful, defibrillate at 200 to 300 joules. (Again, if VF
recurs, use the energy level previously successful.)
(d) If still unsuccessful, defibrillate up to 360 joules.
(e)
If there is no pulse, perform CPR.
(f)
Establish IV access.
(g) Administer epinephrine, 1:10,000, 0.5 - 1.0 mg IV Push. (Repeat
epinephrine every 5 minutes.)
(h)
Intubate, if possible.
(i)
Administer lidocaine, 1 mg/kg IV Push.
(j) Defibrillate with up to 360 joules. (Again, if VF occurs, defibrillate
with the energy level previously successful.)
(k)
Administer bretylium, 5 mg/kg IV Push.
(l)
Consider bicarbonate.
(m) Defibrillate with up to 360 joules. (If VP recurs, defibrillate with the
energy level previously successful.)
(n) Administer bretylium, 10 mg/kg IV Push.
(o) Defibrillate with up to 360 joules. (If VF recurs, defibrillate with the
energy level previously successful.)
(p) Administer either lidocaine or bretylium.
(q) Defibrillate with up to 360 joules. (If VF recurs, defibrillate with the
energy level previously successful.)
MD0571
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