Clinical meaning
The clinician leads advanced life support following current resuscitation guidelines. The cardiac arrest algorithm begins with high-quality CPR (rate 100-120 compressions per minute, depth 5-6 cm, full chest recoil, minimal interruptions) and rapid rhythm identification. Shockable rhythms: ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) -- immediate defibrillation with biphasic device at manufacturer-recommended energy (typically 120-200 J initial, maximum energy for subsequent shocks), followed by immediate resumption of CPR for 2 minutes before rhythm recheck. Epinephrine 1 mg IV/IO every 3-5 minutes (after the second shock for VF/pVT; as soon as possible for non-shockable rhythms). Amiodarone 300 mg IV bolus after the third shock for refractory VF/pVT, then 150 mg if VF/pVT persists. Non-shockable rhythms: asystole and pulseless electrical activity (PEA) -- CPR, epinephrine, and treatment of reversible causes (H's and T's: Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/hyperkalemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary, Thrombosis coronary). The clinician manages the post-cardiac arrest care: targeted temperature management (32-36 degrees Celsius for 24 hours for comatose survivors), coronary angiography for suspected cardiac etiology, hemodynamic optimization (MAP greater than or equal to 65 mmHg), seizure management, and neuroprognostication (multimodal approach at 72 hours or more including neurological examination, EEG, somatosensory evoked potentials, NSE, and neuroimaging).