| Letter |
Intervention |
Note |
| S |
Shock |
360J* monophasic, 1st and subsequent shocks.
(Shock every 2 minutes if indicated) |
| C |
CPR |
After shock, immediately begin chest compressions followed by respirations (30:2 ratio) for 2 minutes.
(Do not check rhythm or pulse) |
| R |
Rhythm |
Rhythm check after 2 minutes of CPR (and after every 2 minutes of CPR thereafter) and shock again if indicated. Check pulse only if an organized or non-shockable rhythm is present. |
Implement the Secondary ABCD Survey. Continue this algorithm if indicated. Give drugs during CPR before or after shocking. Minimize interruptions in chest compressions to <10 seconds. Consider Differential Diagnosis. |
| E |
Epinephrine |
1 mg IV/IO q3-5 min. Or vasopressin 40 U IV/IO, once, in place of the 1st or 2nd dose of epi. |
A
M |
Antiarrhythmic
Medications |
Consider antiarrhythmics. (Any Legitimate Medication)
Amiodarone 300mg IV/IO, may repeat once at 150mg in 3-5 min. if VF/PVT persists or
Lidocaine (if amiodarone unavailable) 1.0-1.5 mg/kg IV/IO, may repeat X 2, q5-10 min. at 0.5-0.75 mg/kg, (3mg/kg max. loading dose) if VF/PVT persists,or
Magnesium Sulfate1-2 g IV/IO diluted in 10mL D5W
(5-20 min. push) for torsades de pointes or suspected/ known hypomagnesemia. |
* Biphasic energy level is device dependent, follow the manufacturer's recommendation. If recommendation is unknown, use 200J for 1st shock and the same or higher energy level for subsequent shocks. |