Perform CPR until Monitor-Defibrillator attached

Consider Possible Causes:
* Hypoxia                 * Hypokalemia                    * Drugs Overdose
* Hyperkalemia        * Preexisting Acidosis         * Hypothermia    

Consider Immediate

Class II b intervention. Must be performed
early simultaneously with drugs

Repeat every 3-5 min

Repeat every 3-5 min ,
up to total of 0.03-0.04 mg/kg

3-5 min after the previous dose

3-5 min after the previous dose

3-5 min after the previous dose

3-5 min after the previous dose

Consider termination of efforts **

Class I     *If patient has known preexisting Hyperkalemia
Class IIa *Preexisting acidosis         *Tricyclic Antidepressants Overdose
Class IIb  *If intubated and continued long arrest interval
                  *Upon return of spontaneous circulation after long arrest interval

* If this approach fails , several Class II b dosing regimens can be considered:
    > Intermediate: Epinephrine 2-5 mg , IV push , every 3-5 min.
    > Escalating:  Epinephrine 1 mg - 3 mg - 5 mg , IV push , 3 min apart.
    > High : 0.1 mg / kg , IV push , every 3-5 min.

**  If patient remain in Asystole or other agonal rhythm after successful Intubation
     and initial medication and no reversible causes are identified , consider termination
     resuscitative efforts by a physician. Consider interval since arrest.

Paramedic Neomi Zvi - Feb 2000

AHA ; ACLS ; 1994 ; 1-23  -  1-27