Technique
- cut through the skin and muscle in the 4th or 5th intercostal space
- divide deeper layers with a blunt instrument
- separate the ribs
- place the heart in right hand with one's palm posteriorly and thumb anteriorly
- compress the heart 80 times per minute
- all drugs except bicarbonate may be delivered by the intracardiac route
- defibrillation paddles are applied over the left ventricle and the front of the heart
- the initial energy should be 0.5 J/kg body weight, this is increased as required
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