If witnessed arrest, give
precordial thump and
check pulse. If absent,
continue CPR

Unresponsive
Call for code team and Defibrillator
Assess breathing (open the airway, look,
listen and feel for breathing)

Secure IV access
Determine probable etiology of arrest
based on history, physical exam, cardiac
monitor, vital signs, and 12 lead ECG.

fibrillation/tachycardia (VT/VF) present on monitor?

Hypotension/shock,
acute pulmonary
edema.

Intubate
Confirm tube placement
Determine rhythm and

Epinephrine 1 mg
IV push, repeat
q3-5min or 2 mg in
10 ml NS via ET tube
q3-5minor

Amiodarone (Cordarone) 300 mg IVPor
Lidocaine 1.5 mg/kg IVP, and repeat q3-5 min, up to total max of 3 mg/kgor
Magnesium sulfate (if Torsade de pointes or hypomagnesemic) 2 gms IVPor
Procainamide (if above are ineffective) 30 mg/min IV infusion to max 17 mg/kg

Continue CPR
Secure IV access
Intubate if no response

Return of
spontaneous
circulation

Pulseless Electrical
Activity
Go to Fig 3

2-2.5 times the IV dose. Dilute in 10 cc of saline.
After each intravenous dose, give 20-30 mL bolus of IV fluid and elevate
extremity.

Assess Airway, Breathing, Circulation, Differential Diagnosis
Administer CPR until defibrillator is ready (precordial thump if witnessed arrest)
Ventricular Fibrillation or Tachycardia present on defibrillator

Epinephrine 1.0 mg IV bolus q3-5 min, or high dose
epinephrine 0.1 mg/kg IV push q3-5 min; may give via
ET tube.

Pericardial tamponade (perform pericardiocentesis)
Tension pneumothorax (perform needle decompression)
Pulmonary embolism (thrombectomy, thrombolytics)
Drug overdose with tricyclics, digoxin, beta, or calcium blockers
Hyperkalemia or hypokalemia
Acidosis (give bicarbonate)
Myocardial infarction (thrombolytics)
Hypothemia (active rewarming)

Idioventricular rhythms
Ventricular escape rhythms
Bradyasystolic rhythms
Postdefibrillation idioventricular rhythms