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- Use of Double sequential defibrillation and vector change defibrillation for persistent VT after 3 consecutive defibrillations, are not established.
- Intravenous access is first choice for drug administration. Intraosseous access is preferred after multiple IV access trials.
- In patients in cardiac arrest with shockable rhythm, Adrenaline is recommended after initial defibrillation attempts have failed.
- Vasopressin with or without Adrenaline is not a substitute for Adrenaline in cardiac arrest.
- No benefit for beta blockers, Bretylium, Sotalol or Procainamide has no benefit for patients with VT or pVT unresponsive to defibrillation.
- Head up CPR is not recommended.
- Use of universal termination of resuscitation for adult patients with OHCA.
- Unstable wide complex tachycardia, synchronized cardioversion is recommended.
- For stable wide complex tachycardia, synchronized cardioversion is recommended if vagal maneuver and adenosine are ineffective.
- Atrial fibrillation (AF)- synchronized cardioversion with 200J (biphasic).
- Double synchronized cardioversion in AF is not useful.
- Atrial flutter– Synchronized cardioversion with 200J (biphasic).
- In persistent symptomatic bradycardia refractory to medical therapy, transvenous pacing is recommended.
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