If pulses are not palpable or are weak or if the patient has a severe bradycardia external cardiac massage is required and treatment should continue as for a cardiac arrest. Hypotension should be treated initially with a fluid challenge although life-threatening hypotension may require blind treatment with epinephrine 0.05-0.2mg increments at 1-2min intervals intravenously until a satisfactory blood pressure is restored. Such treatment should not be prolonged without circulatory monitoring to ensure adequacy of cardiac output as well as correction of hypotension.

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