Download cardiac arrest-ventricular fibrillation/pulseless

Monterey County EMS System Policy
Protocol Number: C-2
Effective Date: July 1, 2015
Review Date: June 30, 2018
CARDIAC ARREST-VENTRICULAR
FIBRILLATION/PULSELESS VENTRICULAR TACHYCARDIA
BLS CARE
Routine Medical Care
CPR. Rotate provision of compressions to prevent rescuer fatigue in order to maintain adequate
chest compressions. Follow AHA guidelines for rate and depth of compressions as well as for
ventilations.
Apply AED immediately when available. Continue chest compressions during application of
the AED pads.
Continue CPR for two minutes even if shock is delivered.
AED rhythm check and assess for spontaneous circulation
Continue resuscitation efforts if no return of spontaneous circulation.
If return of spontaneous circulation, treat the patient based on condition.
ALS CARE
Routine Medical Care.
Defibrillate. 360Joules if monophasic defibrillator. Use setting appropriate for biphasic
defibrillator.
Repeat defibrillation attempt every 2 minutes for continued Ventricular Fibrillation or Pulseless
Ventricular Tachycardia.
Resume CPR immediately after defibrillation.
Epinephrine 1mg 1:10,000 IV/IO. Repeat every 4 minutes until return of spontaneous
circulation.
Continue CPR for two minutes.
Capnography is mandatory during resuscitation efforts and shall be placed as soon as practical.
Lidocaine or Amiodarone
 Lidocaine 1.5mg/kg IV/ IO. May repeat one time in 4 minutes. Maximum dose
3mg/kg.
 Amiodarone 300mg IV/IO. May give second dose of 150mg one time in 4 minutes.
Continue CPR for two minute intervals.
If return of spontaneous circulation or change in rhythm, use appropriate protocol to treat patient
based on condition.
Return Of Spontaneous Circulation (ROSC)
If there is a return of pulses, place the patient on the 12-Lead EKG and transport to the most
accessible STEMI Receiving Center. Transmit the 12-Lead EKG as soon as practical.
Ventilate the patient who is not breathing or with inadequate breathing 10-12 breaths/minute to
achieve end tidal CO2 of 35-45mmHg.
Maintain Oxygen saturation above 94% using the lowest O2 concentration possible.
Consider fluid challenge Normal Saline 500cc to maintain systolic BP above 90 systolic.
Dopamine 5-20ugm/kg/min to maintain BP above 90 systolic.
Consider Lidocaine or Amiodarone drip. Continue use of the same drug used during
resuscitation.
 Lidocaine 1-4mg/minute IV drip.
 Amiodarone 1mg/minute IV drip.
NOTE:
Patients with pulses after cardiac arrest where the cause of the arrest is clearly determined to be
other than cardiac such as drowning or electrocution are to be transported to the closest ED.