If unwitnessed and no bystander CPR, perform CPR for 2 minutes
If EMS witnessed or bystander CPR in progress, defibrillate immediately
Defibrillate at 360 joules (or biphasic equivalent)
Epinephrine 1 mg (10 ml 1:10,000) IV/IO every 3 to 5 min during arrest
OR
Vasopressin 40 units IV/IO for 1st or 2nd of Epinephrine
Defibrillate at 360 joules (or biphasic equivalent) if still VF or VT
Amiodarone 300 mg IV/IO. May repeat Amiodarone 150 mg IV/IO in 3-5 min
OR
Lidocaine 1.5 mg/kg IV/IO. May repeat Lidocaine in 3-5 min 0.5-.75 mg/kg
Defibrillate at 360 joules (or biphasic equivalent) after each drug administration
Consider sodium bicarbonate 1 mEq/kg IV/IO for pre-existing conditions
Asystole/PEA
Confirm asystole in two leads
Search for and treat possible causes: tension pneumothorax, hypovolemia, hypoxia, drug overdose, hypo/hyperthermia, pulmonary embolism, acidosis, cardiac tamponade
Epinephrine 1 mg (10 ml of 1:10,000) IV/IO. Repeat every 3-5 minutes for duration of cardiac arrest
OR
Vasopressin 40 units IV/IO for 1st or 2nd dose of Epinephrine
Consider Sodium bicarbonate 1 mEq/kg IV/IO for pre-existing conditions