P604

• Obtain 12 lead ECG

If STABLE patient:

• Vagal maneuvers
• Contact medical control
• Adenosine 0.1 mg/kg IV rapid push (maximum first dose 6 mg); may repeat with dose doubled (maximum second dose 12 mg)
• Only on the conscious patient and the order of a medical control physician, administer midazolam 0.1 mg/kg (max 5 mg) IV/IO or other medications as directed by medical control) and deliver synchronized cardioversion 0.5 J/kg
• If unsuccessful, repeat synchronized cardioversion at 1 J/kg
• If unsuccessful, repeat synchronized cardioversion at 2 J/kg
• Round the joules up

If UNSTABLE patient:

• Contact medical control
• Midazolam 0.1 mg/kg (max 5 mg) IV/IO
• Synchronized cardioversion 0.5 J/kg.
• If unsuccessful, repeat synchronized cardioversion at 1 J/kg
• If unsuccessful, repeat synchronized cardioversion at 2 J/kg
• Round the joules up

P603

• If symptomatic give oxygen, use BVM as needed, and recheck pulse rate
• If HR <60, BVM and chest compressions
• Epinephrine 1:10,000 IV/IO at 0.1 ml/kg or 1:1000 at 0.1 ml/kg via ETT (max dose 2 ml)
• Contact medical control
• Repeat epinephrine every 5 minutes
• After epinephrine, consider 1 dose of atropine, 0.02 mg/kg (min 0.1 mg, max 1.0 mg) IV/
• IO (ETT = 0.04 mg/kg)
• If hypotensive, 0.9% NaCl 20 ml/kg IV