Page 280 - PJ MED OPS Handbook 8th Ed

Adult ACLS Cardiac Arrest (Circular)
Adult Cardiac Arrest Circular Algorithm
CPR Quality
• Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and
allow complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Change compressor every 2 minutes, or sooner if fatigued.
Start CPR • If no advanced airway, 30:2 compression-ventilation ratio.
• Give oxygen • Quantitative waveform capnography
• Attach monitor/defibrillator – If Petco 2 is low or decreasing, reassess CPR quality.
Return of Spontaneous Shock Energy for Defibrillation
2 minutes
Circulation (ROSC)
• Biphasic: Manufacturer recommendation (eg, initial dose of
Check Post–Cardiac 120-200 J); if unknown, use maximum available. Second and
Rhythm Arrest Care subsequent doses should be equivalent, and higher doses may
If VF/pVT
Shock be considered.
• Monophasic: 360 J
Drug Therapy Drug Therapy
Continuous CPR Quantitative waveform capnography Continuous CPR • Amiodarone IV/IO dose: First dose: 300 mg bolus. Second
IV/IO access
Epinephrine every 3-5 minutes
• Epinephrine IV/IO dose: 1 mg every 3-5 minutes
Amiodarone or lidocaine
for refractory VF/pVT
dose: 150 mg.
or
Consider Advanced Airway
• Lidocaine IV/IO dose: First dose: 1-1.5 mg/kg. Second dose:
0.5-0.75 mg/kg.
Advanced Airway
Treat Reversible Causes
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm and monitor
Monitor CPR Quality
ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds
(10 breaths/min) with continuous chest compressions
Return of Spontaneous Circulation (ROSC)
• Pulse and blood pressure
• Abrupt sustained increase in Petco 2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves with intra-arterial
monitoring
Reversible Causes
• Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
• Hypo-/hyperkalemia • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
© 2020 American Heart Association

278 n Pararescue Medical Operations Handbook / 8th Edition