503-B VENTRICULAR FIBRILLATION/PULSELESS VENTRICULAR TACHYCARDIA

In monitored arrests, administer a Precordial Thump.
Immediately Defibrillate* using 200 joules.
- NOTE:
  IF PATIENT HAS A PERMANENT PACEMAKER IN PLACE, PLACE THE PADDLES OR SEMI-AUTOMATIC DEFIBRILLATOR PADS AT LEAST 5 INCHES AWAY FROM THE PACEMAKER DEVICE.
  
  Repeat Defibrillation* using 300 joules.
  Repeat Defibrillation* using 360 joules.
Perform Endotracheal Intubation. Oxygenate via Bag-Valve-Device or a manually operated resuscitator.
- NOTE:
  A PARAMEDIC MAY PERFORM STEPS 1, 2, 3, 6, 8, and 10 EVEN WHEN ALONE.
Begin an IV infusion of Dextrose 5 % in water (D5W) to keep vein open.
Administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus, every 5 minutes.
Defibrillate*.
Administer Lidocaine 1.0 mg/kg, IV bolus. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)
Defibrillate*.
Administer Bretylium Tosylate 5.0 mg/kg, IV bolus.
Defibrillate*.
* Immediately following conversion to a supraventricular rhythm (even if only of a short duration), administer lidocaine 1.0 mg/kg, IV bolus. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)
Contact Medical Control for implementation of one or more of the following options:

OPTION A:: Repeat any of the above Standing Orders.
OPTION B:: Administer Lidocaine 0.5-1.0 mg/kg, IV bolus. Repeat doses of Lidocaine 0.5-1.0 mg/kg, IV bolus, may be given every 5 minutes up to a maximum dosage of 3.0 mg/kg, and may be followed by an IV drip at a rate of 1.0-4.0 mg/min. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)
OPTION C:: Administer Bretylium Tosylate 10 mg/kg, IV bolus.
OPTION D:: Administer Sodium Bicarbonate 88 mEq, IV bolus. Repeat doses of Sodium Bicarbonate 44 mEq, IV bolus, may be given every 10 minutes.
OPTION E:: Administer Dextrose 25 gm (50 ml of a 50% solution), IV bolus.
OPTION F:: Transportation decision.

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