Scene Safety
- Ensure the scene is safe before approaching the patient. Don proper PPE.
- Request backup if the scene is unsafe or patient is combative.
Assessment
- Check responsiveness and breathing simultaneously.
- If unresponsive and not breathing normally, activate the cardiac arrest protocol.
- Begin high-quality CPR immediately.
High-Quality CPR
- Compression rate: 100–120 per minute
- Compression depth: at least 2 inches (5 cm)
- Recoil: Allow full chest recoil between compressions
- Minimize interruptions: Limit pauses to less than 10 seconds
Defibrillation
- Apply AED pads or defibrillator pads as soon as available.
- Analyze rhythm and shock as indicated.
- Resume CPR immediately after each shock for 2 minutes before reanalyzing.
Medication Administration
- Administer epinephrine 1 mg IV/IO every 3–5 minutes during arrest.
- Consider amiodarone 300 mg for refractory VF/VT after the third shock.
- Follow local standing orders for all medication administration.
Post-ROSC Care
- Maintain SpO2 between 94% and 98%.
- Obtain a 12-lead ECG as soon as possible.
- Maintain target ETCO2 of 35–45 mmHg.
- Consider therapeutic hypothermia per protocol.
- Transport to the appropriate receiving facility with cardiac alert.