CPR No Minimum 100 and no greater than 120 compressions per minute
Ventilation 1 second and not 2
Oxygen – initially not required (unless hypoxia is primary cause of arrest). Attach O2 when no interruption in CPR will be possible.
Pause of no longer than 5 seconds between sets of chest compressions
Defib as soon as possible (do not do 2 minutes of CPR when you first arrive)
Continue compressions while charging
As soon as defib is charged quick look to confirm and deliver shock (no more than 5 seconds off compressions). Note this is not possible with the Zoll AED Pro as the rescuer must be “off chest” for analysis.
The person doing the compressions must be the same person who delivers the shock for H&S reasons
Precordial thump is indicated if witness AND monitored arrest
All ETT should be stored and used uncut (tape is not suitable to hold tubes uncut in position)
Shockable Algorithm (VF/pulseless VT): • Adrenaline 1:10,000 (1mg) should be administered once chest compressions have been restarted after the delivery of the 3rd shock and then repeated every 3-5 minutes post alternate shocks. • Amiodarone (300mg) should be administered after the third shock (post adrenaline) in refractory VF/VT. A further dose of 150mg may be given if the patient remains in VF/VT after the 5th shock.
Non-shockable Algorithm Non-shockable side of algorithm (asystole/PEA) • Adrenaline 1:10,000 (1mg) is to be administered for asystole and PEA as soon as IV access is achieved, and repeated every 3-5 minutes whilst the patient remains in cardiac arrest. • Atropine has been removed from the Asystole and PEA algorithm
Flushing Drugs • All drugs injected peripherally (including external jugular) must be flushed with at least 20mls of Sodium Chloride (NaCl) 0.9%. A bag of fluid with 3 way tape is best way to achieve this.
Drug Routes Endotracheal route is no longer indicated If IV access is not gained with 2 minutes IO access should be sought.
Below is an Example of how an adult VF arrest could be run – this is only one approach that could be adopted – there are many other ways to do this.