›Core cardiac arrest management
›High-quality CPR
›Minimal interruptions
›Compressor switch every 2 minutes
›Defibrillation strategy for shockable rhythms
›Biphasic 120-200 J initial if unknown device default
›Escalate energy for subsequent shocks
›Epinephrine timing
›Non-shockable
›Initiate epinephrine as soon as feasible
›Shockable
›Initiate epinephrine after initial defibrillation attempts and ongoing CPR
›Antiarrhythmic use for refractory VF or pVT
›Amiodarone or lidocaine options
›Medication dosing and sequences
›Epinephrine IV/IO 1 mg
›Repeat every 3-5 minutes
›Class I recommendation for cardiac arrest (AHA)
›Amiodarone IV/IO for refractory VF or pVT
›300 mg bolus
›Additional 150 mg bolus if needed
›Class IIb recommendation for refractory VF or pVT (AHA)
›Lidocaine IV/IO alternative for refractory VF or pVT
›1.0-1.5 mg/kg bolus
›Additional 0.5-0.75 mg/kg bolus
›Maximum 3 mg/kg total
›Class IIb recommendation for refractory VF or pVT (AHA)
›Magnesium sulfate IV for torsades
›2 g bolus
›Repeat once if refractory
›Class IIa recommendation for torsades (AHA)
›Sodium bicarbonate IV
›1 mmol/kg for specific indications
›Tricyclic antidepressant toxicity
›Hyperkalemia with ECG changes
›Severe metabolic acidosis with prolonged arrest and specific guidance
›Routine use not recommended (Class III no benefit, AHA)
›Calcium chloride IV for specific indications
›10 mL of 10% solution
›Hyperkalemia with ECG changes
›Calcium channel blocker overdose
›Hypocalcemia
›Dextrose for hypoglycemia
›If glucose <3.0 mmol/L, dextrose IV per local concentration and protocol
Reversible cause directed therapies
›Cause-specific interventions
›Tension pneumothorax
›Immediate needle decompression or finger thoracostomy if trained
›Chest tube placement
›Cardiac tamponade
›Pericardiocentesis if tamponade physiology and arrest
›Massive PE
›Systemic thrombolysis consideration during arrest when high suspicion and no contraindication
›Opioid toxicity
›Naloxone pathway if respiratory arrest suspected and pulses present
›Prioritize ventilation and oxygenation if pulseless
›Hypothermia
›Active rewarming
›Prolonged resuscitation consideration until rewarmed in severe hypothermia
›Post-ROSC hemodynamics and neuroprotection
›Fluids and vasopressors
›Norepinephrine infusion if shock
›Initiate 0.05-0.1 mcg/kg/min
›Titrate every 2-5 minutes to MAP ≥65 mmHg
›Sedation and analgesia if intubated
›Avoid hypotension from oversedation
›Targeted temperature management
›Temperature control strategy for comatose survivors
›Prevent fever
›Seizure management
›Benzodiazepine for convulsive seizure
›Continuous EEG when available for refractory coma or suspected nonconvulsive seizures
›Coronary reperfusion therapy
›Emergent angiography for STEMI (Class I, AHA)
›Consider early angiography for shockable rhythm with suspected cardiac cause (Class IIa, AHA)
Airway confirmation and ventilation safety
›Airway and ventilation safety checks
›Continuous waveform capnography for intubated patients
›Tube confirmation
›CPR quality feedback
›ROSC detection adjunct
›ACEP evidence grading label
›Level B or C depending on local policy
›Ventilation strategy post-ROSC
›Avoid hyperventilation
›Avoid severe hypocapnia
›SpO2 94-98%