Alright, I know you're probably clear on a lot of the things I'm going to say, but just hear with me for a minute...the better you organize the code at the beginning, the less trouble you will have keeping track of where you are at.
First, ensure that CPR is occurring and that it is effective.
Second, make sure that you have the monitor attached with leads and defib pads. Once this is done, clear and analyze the rhythm.
From this point on I find the following cadence to be most useful in making sure you don't forget anything: Compressions, Monitor Medication, in that order always...
So, for example, if the rhythm is VF/Pulseless VT, i would generally say something like this:
(Look at compressors) Resume compressions
(Look at monitor person) charge the monitor to 200 J, clear and defibrillate when you are ready
(Look at medication person) prepare 1 mg of epinephrine 1:10 and administer it immediately after the defibrillation.
Once I've given these orders, I'm basically free for the next two minutes while they perform high quality CPR.
After 2 minutes if they still present with VF/VT (this is what the manual classifies as refractory), I essentially repeat the process with the exact same orders, except instead of epi, I order 300 mg of amiodarone.
resume compressions, charge to 200 and shock when you're ready, prepare 300 mg amiodarone and administer it immediately after the shock.
And this repeats every two minutes, and all I have to do is keep track of what I gave last and what the rhythm is on analysis. If I follow this cadence, it spaces my epi administration at about every 4 minutes (exactly between 3 and 5) and it spaces my antidysrhythmic at about 4 minutes.
Also, remember, in the shockable VF/VT scenario, you are always alternating between a vasopressor and an antidysrhythmic. So the med cycle goes: 1 mg epi, 300 mg amiodarone, 1 mg epi, 150 mg amiodarone, 1 mg epi, (antidysrhythmic of your choice), 1 mg epi, (antidysrhythmic of your choice), and so on until there is a status change or I terminate. Remember, there is 2 minutes of high quality CPR and a defibrillation if appropriate between all of those meds.
Also, if you find yourself with an asystole/ PEA patient, simply replace the antidysrhythmic meds in the previous cadence I mentioned with a cycle of no medication, as epi is the only med we give in that algorithm (unless you are correcting an overdose, toxins or acidosis, but those are special considerations) , and again, it's timing is every 3-5 mins.
so yeah, sorry for the long winded reply, but hopefully there was something of value there for you...I was a flight paramedic for 13 years before med school and have taught all the card courses for longer than I can remember. This is by far the easiest way I've found that works in both principle and practice...
