Cardiac Arrest

1. Follow General Medical Protocol.

2. Follow AHA ACLS guidelines for cardiac arrest. Treat based on presenting rhythm:

a. Asystole

b. Ventricular Fibrillation / Pulseless Ventricular Tachycardia

c. Pulseless Electrical Activity

3. Begin CPR before defibrillation attempt. Ideally, providers should perform 2 minutes of CPR prior to defibrillation. EMS providers MUST coordinate care in order to minimize interruptions in chest compressions. Apply Auto-Pulse  Mechanical Compression device if available.

4. Ventilate with the BVM and place advanced airway (iGel); prepare to intubate.

5. Initiate IV access with "Isotonic Fluids" (0.9% NORMAL SALINE or Lactated Ringers) at TKO rate.

a. If unable to start IV, initiate IO access.    All IV drug doses remain the same for IO.

5. The cardiac arrest patient should have initial procedures and medications before transport. (This DOES NOT apply in traumatic cardiac arrest.)

6. If the patient is a DIALYSIS PATIENT, administer:

a. CALCIUM CHLORIDE 10% 10 mL IV

b. SODIUM BICARBONATE 1 mEq/kg IV (~ 1 to 2 amps)

VENTRICULAR FIBRILLATION / PULSELESS V – TACH

1. Continue CPR.

2. Defibrillate immediately @ 200 joules and resume CPR for 2 minutes.

3. If no response, administer EPINEPHRINE 1:10,000 1 mg IV and repeat every 3 - 5 minutes as long as patient is in cardiac arrest.  Repeat defibrillation.

4. If no response, administer AMIODARONE 300 mg IV. (May repeat once @ 150 mg.)  Repeat defibrillation.

5. Alternate EPINEPHRINE and AMIODARONE with defibrillations. (Amiodarone may only be given twice – once @ 300 mg and subsequently @ 150 mg).

6. If ventricular fibrillation or pulseless ventricular tachycardia continues unchanged after 4 (four) defibrillations, you may use Double Sequential Defibrillation (see protocol).

7. If no response to above AND you anticipate prolonged transport time give loading dose of LIDOCAINE 1 mg/kg and start LIDOCAINE DRIP @ 2 mg/min. (This should only be done IF above amiodarone dosage given AND patient remains in ventricular fibrillation/pulseless ventricular tachycardia.)

8. If polymorphic ventricular tachycardia (“torsades”) is present, administer MAGNESIUM SULFATE 50% 2 grams IV over 2 minutes. 

PULSELESS ELECTRICAL ACTIVITY

1. Continue CPR.

2. Administer EPINEPHRINE 1:10,000 1 mg IV every 3 – 5 minutes.

ASYSTOLE

1. Continue CPR.   Assess rhythm in 2 leads.

2. Administer EPINEPHRINE 1:10,000 1 mg IV every 3 – 5 minutes.

a. If no IV access, administer 2 – 2.5 mg via ETT

POST-RESUSCITATION

1. Follow the Medical Shock Protocol

2. Initiate hypothermia by applying ice packs around neck, groin, and axillae.

3. Perform & transmit 12-lead EKG.