![]() ![]() Point-of-care ultrasound (POCUS), if available and not interfering with CPR, may be helpful to identify the cause of cardiac arrest. Based on the patient’s cardiac arrest situation or medical history, immediate identification and treatment of the reversible causes of cardiac arrest may facilitate ROSC. If the VF or pVT persists, a second dose of amiodarone 150 mg or lidocaine 0.5 to 0.75 mg/kg can be administered. The recommended first dose is 300 mg for amiodarone or 1 to 1.5 mg/kg for lidocaine. Amiodarone or lidocaine can be prepared for refractory VF or pVT that is unresponsive to the second shock and may be administered immediately after the third shock. If a shockable rhythm persists after 2 minutes of CPR, the provider should deliver another shock and resume CPR. If endotracheal intubation has been performed, monitoring of the end-tidal carbon dioxide (ETCO 2) can assess the CPR quality and detect ROSC. If an advanced airway is in place, it is reasonable to deliver 1 breath every 6 seconds (10 times/min) with continuous chest compressions. Meanwhile, another provider should consider performing advanced airway management and capnography. If a shockable rhythm persists, the provider should deliver another shock with equivalent or higher energy than the previous defibrillation and resume CPR immediately. After 2 minutes of CPR, the ECG rhythm should be checked. Administration of 1 mg epinephrine should be repeated every 3 to 5 minutes while ALS continues. The IO route should be attempted only if the IV access is unsuccessful or not feasible. After the first shock is delivered, an intravenous (IV) or intraosseous (IO) route for drug administration should be established, and a 1 mg bolus of epinephrine should be administered, followed by a bolus of IV fluids. If the provider cannot identify the manufacturer’s recommended dose of the biphasic defibrillator, defibrillation (shock) should be conducted at 200 J. 1Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, KoreaĢDepartment of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, KoreaģDepartment of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, KoreaĤDepartment of Emergency Medicine, Seoul National University College of Medicine, Seoul, KoreaĥDepartment of Internal Medicine, Ewha Womans University College of Medicine, Seoul, KoreaĦDepartment of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, KoreaħDepartment of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, KoreaĨDepartment of Emergency Medicine, Yonsei University College of Medicine, Seoul, KoreaĩDepartment of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Koreaġ0Department of Pediatrics, Seoul National University College of Medicine, Seoul, Koreaġ1Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Koreaġ2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Koreaġ3Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Koreaġ4Department of Pediatrics, Ulsan University College of Medicine, Seoul, Koreaīecause VF and pVT can be terminated with defibrillation, they are also known as “shockable rhythms.” Providers should deliver a single shock (biphasic wave defibrillator: 120–200 J, monophasic wave defibrillator: 360 J) when a shockable rhythm is confirmed on the ECG monitor and resume CPR immediately for 2 minutes, beginning with chest compressions without a pulse check or ECG rhythm analysis.
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