EMS is dispatched for a 47 year old male who is unconscious with abnormal breathing. A double BLS ambulance arrives on scene first. The patient is at first poorly responsive and moaning, but soon after develops agonal respirations and is found to be pulseless. CPR is initiated and an AED is applied. He is found to be in PEA at the first pulse check. The paramedic arrives 3 minutes later and establishes intravenous access.
What medications, if any, should be given and why? Are there historical factors or rhythm characteristics that affect this decision? What if the rhythm is ventricular fibrillation?
Within the last few years, a number of studies have challenged the role of medication administration in the treatment of out-of-hospital cardiac arrest. Have these changed your practice and how?
Please share your thoughts (ideally with citations!) by January 15th. A summary post will be published in January.