Edgar Wilmont

You are doing your morning rounds when you hear 'Code Blue, Medicine 1' over the loudspeaker. As a resident in the hospital, you know you will likely be playing a team leader role, at least initially, with this code.

You quickly make your way to the room. There are three nurses already there, and chest compressions are underway.

One of the nurses gives you a quick history: Mr Wilmont is 68 years old. He was admitted two days ago with acute myocardial infarction. He was found pulseless, though his vitals were stable and he was fine 30 minutes ago.

CPR is underway.

Administer oxygen if available.

Attach a monitor and check the rhythm.

Secure IV/IO access.

Work to secure airway.

The rhythm shows ventricular fibrillation.

Give one shock:     manual biphasic: device specific: 120-200 J,        AED: device specific         monophasic: 360J

Resume CPR, give 5 cycles, and check rhythm.

When avaialble, given vasopressor:

• epinephrine 1mg IV/IO q 3-5 min or
• vasopressin 40 U IV/IO x1

Continue with 5 cycles and do a rhythm check.

The rhythm continues to show ventricular fibrillation.

During the second, or subsequent rounds of CPR, consider:

• amiodarone 300 mg IV/IO once, and then 150 mg IV/IO once, or
• lidocaine 1-1.5 mg/kg, the 0.5-0.75 mg/kg, to a maximum of 3 doses or 3 mg/kg

Consider magnesium 1-2g IV/IO for torsades de pointes

You do a rhythm check after the next five cycles.

Rhythm shows asystole.

Continue giving epinephrine 1mg IV/IO every 3-5 min.

Consider atropine 1mg IV/IO for asystole every 3-5 min, to a maximum of 3 doses.

Consider the H's and T's:

• hypovolemia
• hypoxia
• hydrogen (acidosis)
• hypo/hyperkalemia
• hypoglycemia
• hypothermia
• toxins
• tamponade
• tension pneumothorax
• thrombosis: coronary or pulmonary
• trauma