Page 87 - 2026 SMOG

MWD CPR
Causes Indications to Initiate CPR
• Traumatic: blast/blunt force/penetrating • Pulselessness
• Non-traumatic: anesthesia/neardrowning/ • Apneic
electrocution
Treatment
• 2-person, closed-chest CPR should be initiated as soon as Cardiopulmonary Arrest (CPA) is
declared.
• Chest compressions (100/min) in lateral recumbency (either side) over the widest part of the
chest
˚ Sustain compressions for 2–3min per cycle
˚
Compress 1/3–1/2 chest width
• Clear airway and intubate ASAP
˚ Perform a tracheostomy if the airway is obstructed
• Manually ventilate (8–10 breaths/min) 100% O 2
˚ Intubate if possible; if intubation is not possible, perform emergent tracheostomy.
• Attain ECG
• Attain IV/IO access
˚ Follow all drugs with a 10mL saline push
Do NOT give large volumes of fluids during CPR, unless MWD is hypovolemic
˚
• Asystole/PEA/Sinus bradycardia
˚ Vasopressin 0.8U/kg IV/IO once and Lowdose Epinephrine 0.01mg/kg IV/IO every other
BLS cycle
˚ Consider Atropine 0.04mg/kg IV/IO every other BLS cycle if bradycardia preceded arrest.
˚ With prolonged CPA >10min, consider
■ Epinephrine HIGH dose (0.1mg/kg IV/IO)
■ Bicarbonate therapy (1–2mEq/kg IV, repeat q10min)
• VF/Pulseless VT
˚ Continue BLS, charge the defibrillator, and apply paddles to either side of the chest.
˚ Clear and give 1 shock; Defibrillate 2–5J/kg biphasic (4–6J/kg monophasic)
■ Immediately start compressions for 1 cycle after every defibrillation attempt
■ Defibrillate twice more if needed at the same energy level, but resume chest compressions
for 1 cycle after each defibrillation
˚ With prolonged VF/VT, consider
■ Epinephrine 0.01mg/kg IV/IO
■ Vasopressin 0.8U/kg IV/IO once + Lidocaine 2mg/kg IV/IO
■ Amiodarone 5–10mg/kg IV/IO
■ Defibrillate at 50% increased energy if refractory
■ Give Magnesium sulfate 30mg/kg IV once if the patient has refractory VT
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 79