Pulseless arrest - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:29Z

Strip excess bold text

← Older revision		Revision as of 09:24, 22 March 2026
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	==General==		==General==
	*~~'''~~A~~'''~~ (adjunct) - Place oropharyngeal airway		*A (adjunct) - Place oropharyngeal airway
	*~~'''~~B~~'''~~ (breathing) - place on [[Ventilator]] to assure slow ventilation rate (attach to BVM mask)		*B (breathing) - place on [[Ventilator]] to assure slow ventilation rate (attach to BVM mask)
	**10-12 bpm, 500cc tidal volume, Fio2 100%		**10-12 bpm, 500cc tidal volume, Fio2 100%
	*~~'''~~C~~'''~~ (compressions) - Switch out providers q pulse check; use metronome		*C (compressions) - Switch out providers q pulse check; use metronome
	**100-120 compressions/min		**100-120 compressions/min
	**Compress to a depth between 2-2.4 inches (5-6 cm)		**Compress to a depth between 2-2.4 inches (5-6 cm)
	**Allow full recoil between compressions		**Allow full recoil between compressions
	*~~'''~~D~~'''~~ - defibrillation		*D - defibrillation
	**May be ok to shock during compressions if wearing gloves and using biphasic device<ref>Lloyd MS, Heeke B, Walter PF, and Langberg JJ. Hands-on defibrillation: an analysis of current flow through rescuers in direct contact with patients during biphasic external defibrillation. Circulation. 2008; 117:2510-2514.</ref>		**May be ok to shock during compressions if wearing gloves and using biphasic device<ref>Lloyd MS, Heeke B, Walter PF, and Langberg JJ. Hands-on defibrillation: an analysis of current flow through rescuers in direct contact with patients during biphasic external defibrillation. Circulation. 2008; 117:2510-2514.</ref>
	**Precharge prior to pulse & rhythm check to increase overall compression time		**Precharge prior to pulse & rhythm check to increase overall compression time
	*~~'''~~A~~'''~~ (advanced airway)		*A (advanced airway)
	**Use [[LMA]] (NOT ET tube - no break in compressions required)		**Use [[LMA]] (NOT ET tube - no break in compressions required)
	*~~'''~~B~~'''~~ (advanced breathing)		*B (advanced breathing)
	**Connect [[LMA]] to [[Ventilator]]		**Connect [[LMA]] to [[Ventilator]]
	***Pressure control 20, RR 10, insp rate 1.5-2s		***Pressure control 20, RR 10, insp rate 1.5-2s
	*~~'''~~C~~'''~~ (advanced circulation)		*C (advanced circulation)
	**Place [[IO]] instead of central line		**Place [[IO]] instead of central line
	*~~'''~~D~~'''~~ (differential)		*D (differential)
	**[[Ultrasound: In Shock and Hypotension]]		**[[Ultrasound: In Shock and Hypotension]]

Danbot: Convert medications to MedicationDose template — single source of truth with SMW; dosing verified against AHA 2020

2026-03-20T15:52:25Z

Convert medications to MedicationDose template — single source of truth with SMW; dosing verified against AHA 2020

← Older revision		Revision as of 15:52, 20 March 2026
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	**Biphasic - 200J		**Biphasic - 200J
	**Monophasic - 360 J		**Monophasic - 360 J
	*Give [[Epi~~]] 1mg~~ if (shock + 2min of CPR) fails to convert the rhythm		*Give {{MedicationDose\|drug=Epinephrine\|dose=1 mg q3-5 min\|route=IV/IO\|context=Pulseless arrest\|indication=Pulseless arrest\|population=Adult\|display=Epi}} if (shock + 2min of CPR) fails to convert the rhythm
	*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails		*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails
	**1st line: [[Amiodarone~~]] 300mg~~ IVP ~~with repeat dose of 150mg as indicated~~		**1st line: {{MedicationDose\|drug=Amiodarone\|dose=300 mg 1st dose, 150 mg repeat\|route=IVP\|context=1st line antiarrhythmic\|indication=Pulseless arrest\|population=Adult}}
	**2nd line: [[Lidocaine]] 1-1.~~5mg~~/kg then 0.5-0.~~75mg~~/kg q5-~~10min (1 or 2%, as long as total mg is correct)~~		**2nd line: {{MedicationDose\|drug=Lidocaine\|dose=1-1.5 mg/kg, then 0.5-0.75 mg/kg q5-10 min\|route=IV\|context=2nd line antiarrhythmic\|indication=Pulseless arrest\|population=Adult}}
	**Polymorphic V-tach: [[Magnesium~~]] 2g IV~~, followed by maintenance infusion		**Polymorphic V-tach: {{MedicationDose\|drug=Magnesium sulfate\|dose=2 g, followed by maintenance infusion\|route=IV\|context=Polymorphic VT\|indication=Pulseless arrest\|population=Adult\|display=Magnesium}}

	==Asystole and PEA (Non-Shockable)==		==Asystole and PEA (Non-Shockable)==
	[[File:PEA.png\|thumbnail]]		[[File:PEA.png\|thumbnail]]
	*~~[[epinephrine~~\|~~Epi]] 1mg~~ q3-~~5min~~		*{{MedicationDose\|drug=Epinephrine\|dose=1 mg q3-5 min\|route=IV/IO\|context=Pulseless arrest (asystole/PEA)\|indication=Pulseless arrest\|population=Adult\|display=Epi}}

	*Three major mechanisms of PEA (3 & 3 Rule)		*Three major mechanisms of PEA (3 & 3 Rule)
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	===Esmolol for Electrical Storm <ref>Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with ventricular fibrillation. Resuscitation. 2014; 85(10):1337-1341.</ref><ref> Boehm KM. First report of survival in refractory ventricular fibrillation after dual-axis defibrillation and esmolol administration. West J Emerg Med. 2016 Nov;17(6):762-765. </ref><ref> Lee YH. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016 Oct;107:150-5. doi: 10.1016. </ref>===		===Esmolol for Electrical Storm <ref>Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with ventricular fibrillation. Resuscitation. 2014; 85(10):1337-1341.</ref><ref> Boehm KM. First report of survival in refractory ventricular fibrillation after dual-axis defibrillation and esmolol administration. West J Emerg Med. 2016 Nov;17(6):762-765. </ref><ref> Lee YH. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016 Oct;107:150-5. doi: 10.1016. </ref>===

	#Administer [[Esmolol~~]] bolus~~ 500 mcg/kg ~~IVP~~ over 30 ~~seconds (typical~~ dose ~~ranges~~ 35-50 mg)		#Administer {{MedicationDose\|drug=Esmolol\|dose=500 mcg/kg over 30 sec\|route=IVP\|context=Refractory VF\|indication=Pulseless arrest\|population=Adult\|notes=Typical dose 35-50 mg}}
	#If ROSC, initiate 50 mcg/kg/min infusion <ref> Al-Khatib SM. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac arrest. Circulation. 2018 Sep 25;138(13):e272-e391. doi: 10.1161 </ref>		#If ROSC, initiate 50 mcg/kg/min infusion <ref> Al-Khatib SM. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac arrest. Circulation. 2018 Sep 25;138(13):e272-e391. doi: 10.1161 </ref>
	#Deliver 200J (or 360J if monophasic) simultaneously from both defibrillators		#Deliver 200J (or 360J if monophasic) simultaneously from both defibrillators
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	==Fibrinolytics==		==Fibrinolytics==
	===Dosing===		===Dosing===
	*Alteplase 0.~~6mg~~/kg ~~IV push x1 given~~ over 15 min (± heparin 5000 unit bolus), and then repeated 30 min after if still no ROSC<ref>Böttiger BW et al. Lancet 2001;357:1583-5.</ref>		*{{MedicationDose\|drug=Alteplase\|dose=0.6 mg/kg over 15 min\|route=IV\|context=PE-related arrest\|indication=Pulseless arrest\|population=Adult\|max_dose=50 mg\|notes=Repeat 30 min after if no ROSC}} (± heparin 5000 unit bolus), and then repeated 30 min after if still no ROSC<ref>Böttiger BW et al. Lancet 2001;357:1583-5.</ref>
	**Heparin may be bolused with tPA or after ROSC obtained		**Heparin may be bolused with tPA or after ROSC obtained
	**Max doses of 50mg may be as efficacious as 100mg		**Max doses of 50mg may be as efficacious as 100mg

Urinetrouble: Clarified concentration of lido for antiarrhythmic agents

2026-01-16T18:14:05Z

Clarified concentration of lido for antiarrhythmic agents

← Older revision		Revision as of 18:14, 16 January 2026
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	*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails		*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails
	**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated		**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated
	**2nd line: [[Lidocaine]] 2% 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min		**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min (1 or 2%, as long as total mg is correct)
	**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion		**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion

Ostermayer at 18:03, 16 January 2026

2026-01-16T18:03:26Z

← Older revision		Revision as of 18:03, 16 January 2026
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	{{~~Adult top}} [[~~pulseless arrest (peds)~~]].''~~		{{AdultPage\|pulseless arrest (peds)}}
	==Immediate==		==Immediate==
	[[File:ACLS-arrest.png\|thumb\|Algorithm for cardiac arrest (Adapted from ACLS 2010)]]		[[File:ACLS-arrest.png\|thumb\|Algorithm for cardiac arrest (Adapted from ACLS 2010)]]

Urinetrouble at 00:35, 18 October 2024

2024-10-18T00:35:30Z

← Older revision		Revision as of 00:35, 18 October 2024
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	*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails		*Give [[antiarrhythmic]] if (2nd shock + 2min of CPR) again fails
	**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated		**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated
	**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min		**2nd line: [[Lidocaine]] 2% 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min
	**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion		**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion

Rossdonaldson1: Reverted edits by Solarczykigor (talk) to last revision by Teledoc4u

2024-01-17T19:22:52Z

Reverted edits by Solarczykigor (talk) to last revision by Teledoc4u

← Older revision		Revision as of 19:22, 17 January 2024
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	**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated		**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated
	**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min		**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min
	**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance ~~infusi~~		**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusion

	==Asystole and PEA (Non-Shockable)==		==Asystole and PEA (Non-Shockable)==

Solarczykigor: /* V-Fib and Pulseless V-Tach (Shockable) */

2024-01-16T21:09:45Z

V-Fib and Pulseless V-Tach (Shockable)

← Older revision		Revision as of 21:09, 16 January 2024
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	**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated		**1st line: [[Amiodarone]] 300mg IVP with repeat dose of 150mg as indicated
	**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min		**2nd line: [[Lidocaine]] 1-1.5mg/kg then 0.5-0.75mg/kg q5-10min
	**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance ~~infusion~~		**Polymorphic V-tach: [[Magnesium]] 2g IV, followed by maintenance infusi

	==Asystole and PEA (Non-Shockable)==		==Asystole and PEA (Non-Shockable)==

Teledoc4u: /* Immediate */

2023-04-20T07:54:54Z

Immediate

← Older revision		Revision as of 07:54, 20 April 2023
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	==Immediate==		==Immediate==
	[[File:ACLS-arrest.png\|thumb\|Algorithm for cardiac arrest (Adapted from ACLS 2010)]]		[[File:ACLS-arrest.png\|thumb\|Algorithm for cardiac arrest (Adapted from ACLS 2010)]]
			#Call for Help/activate Code Blue
	#Start [[CPR]]		#Start [[CPR]]
	#Give oxygen		#Give oxygen

Elcatracho: /* Immediate */

2021-01-22T01:48:18Z

Immediate

← Older revision		Revision as of 01:48, 22 January 2021
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	#Start [[CPR]]		#Start [[CPR]]
	#Give oxygen		#Give oxygen
	#Attach monitor/~~defibrilator~~		#Attach monitor/[[Defibrillation\|defibrillator]]
	#Rhythm shockable?		#Rhythm shockable?

Elcatracho: /* Stellate Ganglion Nerve Block Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260. */

2020-11-29T18:06:34Z

Stellate Ganglion Nerve Block Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260.

← Older revision		Revision as of 18:06, 29 November 2020
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	===[[Stellate Ganglion Nerve Block]] <ref>Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260. </ref>===		===[[Stellate Ganglion Nerve Block]] <ref>Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260. </ref>===
			[[File:stellate ganglion block.png\|thumb\|The red star above denotes the intended target for lidocaine injection<ref>Margus, C, Correa, A, Cheung, W, et al. Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation. Ann Emerg Med. 2020;75(2):257–260.</ref>]]

	#Place probe over left anterior neck		#Place probe over left anterior neck
	#Identify thyroid gland, carotid artery, C6/C7, longus colli muscle, and prevertebral fascia		#Identify thyroid gland, carotid artery, C6/C7, longus colli muscle, and prevertebral fascia