Question

You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the patient was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IO access has been established. Which intervention would be your next action?

- Dopamine at 10 to 20 mcg/kg per min
- Epinephrine 1 mg
- Atropine 1 mg
- Intubation and administartion of 100% oxygen

Answer 1

In a cardiac arrest scenario with ongoing CPR, the first intervention should be the administration of Epinephrine 1 mg through IV or IO access. Intubation and oxygenation are also critical but should not delay the administration of epinephrine or chest compressions.

Step-by-step explanation:

Given that the patient has no pulse or respirations and CPR is already in progress, the priority intervention would be to administer Epinephrine 1 mg intravenously or through the intraosseous (IO) access that has already been established. Epinephrine is the first-line medication for someone in cardiac arrest due to its ability to increase coronary and cerebral blood flow during CPR. It also has vasoconstrictive properties that can help to restore spontaneous circulation.

According to the latest guidelines, atropine is no longer recommended for routine use in managing asystole or pulseless electrical activity (PEA) cardiac arrests. Dopamine is also not the first-line medication for cardiac arrest but may be considered later in the treatment protocol if there are signs of return of spontaneous circulation (ROSC) with continued low blood pressure. Moreover, while intubation and administration of 100% oxygen are important, the administration of epinephrine takes precedence in a cardiac arrest scenario since securing the airway should not delay drug therapy and essential chest compressions. After administering epinephrine, ensuring proper advanced airway management is the next step.