V-Fib/Pulseless V-Tach

  • 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
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