Circulation -airway- rescue breathing

1. Confirm no pulse, start CPR immediately
2. Insert oropharyngeal or nasal phalanx your airway, begin bag-valve you mask BVM/Ambu-bag ventilation with 100% oxygen
3. Compression to ventilation rate 30:2
4. Attach monitor/defibrillator and check rhythm
5. Shock if VFib/V-tach, resume CPR immediately for 2 minutes. 
6. If asystolic, PEA, give epi 1 mg IV and continue CPR for 2 minutes
7. Switch chest compressors and do pulse/ rhythm check every 2 minutes
8. Continue giving epinephrine every 3-5 minutes
9. If subsequent rhythm checks reveal persistent V-tach VFib nonresponsive to defibrillation, give amiodarone 300 mg IV bolus, can repeat another dose of 150 mg
10. Endotracheal intubation can be deferred until after return of spontaneous circulation (ROSC) 
11. Contact family and consider termination of CPR after 20 minutes if no ROSC and family agreeable otherwise continue CPR for full 40 minutes.  
12. If still no ROSC CPR can be terminated.

From Current hospital medicine 2023, Amil Rafiq MD