Summary
Highlights
If after repeating amiodarone and completing five cycles of CPR, the rhythm is asystole, which is not shockable, the team must resume high-quality CPR.
The patient experiences a return of spontaneous circulation (ROSC) with a blood pressure of 90/60, but without spontaneous breathing, requiring ventilation.
At this point, consider administering amiodarone or lidocaine IV or IO.
The appropriate second dose of amiodarone is 150 milligrams IV or IO.
A 52-year-old woman with hypertension and type 2 diabetes presents to the ER with chest pain, jaw radiation, and shortness of breath. Initial assessment reveals clammy skin, regular heart rate, clear lungs, and labored breathing. The patient is anxious and uncomfortable.
The initial rhythm is identified as Normal Sinus Rhythm (NSR) with Premature Ventricular Contractions (PVCs), characterized by early, wide, bizarre QRS complexes and no discernible P waves.
The immediate intervention is to obtain a 12-lead EKG to determine if there is underlying ischemia.
While starting an IV, the patient vomits, loses consciousness, and the monitor reveals a new rhythm indicative of cardiac arrest.
Upon recognizing cardiac arrest, the immediate action is to begin high-quality CPR. If the rhythm is shockable, prepare for defibrillation, but do not delay CPR.
After defibrillation, the next crucial step is to consistently resume high-quality CPR without delay.
If the monitor continues to show V-fib after CPR, the next appropriate intervention is to defibrillate again, as V-fib is a shockable rhythm.
If a shockable rhythm persists after high-quality CPR and two defibrillations, the team should administer epinephrine one milligram IV.
Epinephrine can be repeated every three to five minutes, with no specific dosing limit.
After administering epinephrine, high-quality CPR is essential to circulate the medication throughout the patient's system.
After epinephrine and five cycles of CPR, the patient remains pulseless, but the rhythm changes to pulseless ventricular tachycardia, which is another shockable rhythm.
Recognizing pulseless ventricular tachycardia, the next intervention is to defibrillate and then immediately begin high-quality CPR.