Treating Ventricular Fibrillation or Pulseless Ventricu

Treating Ventricular Fibrillation or Pulseless Ventricular Tachycardia : 

Treating Ventricular Fibrillation or Pulseless Ventricular Tachycardia Galveston College EMS 2010

What is Ventricular Fibrillation? : 

What is Ventricular Fibrillation? 2/121

Slide 3: 

Ventricular fibrillation Rhythm in which the entire heart is no longer contracting Quivering without organized contraction Random depolarization of many cells Rhythm most commonly seen Responds well to defibrillation

Slide 8: 

8/121 Ventricular Fibrillation Etiology Wide variety of causes, often resulting from advanced coronary artery disease. Clinical Significance Lethal dysrhythmia with no cardiac output and no organized electrical pattern.

Slide 9: 

Treatment for V-fib or pulseless V-tach Most likely to be successfully resuscitated Check the ABCs. Perform CPR for 2 minutes while the defibrillator is being attached. Shock at maximum Joules setting. Confirm V-fib or V-tach on the monitor-defibrillator. Confirm absence of a pulse. Resume CPR while charging the defibrillator. Clear the patient and then defibrillate.

Slide 10: 

If the rhythm is persistent V-fib or V-tach Resume CPR while charging the defibrillator. Clear the patient and then defibrillate. Consider an advanced airway. Start an IV with normal saline. Consider establishing IO access.

What is Ventricular Tachycardia : 

What is Ventricular Tachycardia

Slide 12: 

Ventricular Tachycardia Etiology 3 or more ventricular complexes in succession at a rate of >100. Causes include myocardial ischemia, increased sympathetic tone, hypoxia, idiopathic causes, acid-base disturbances, or electrolyte imbalances. VT may appear monomorphic or polymorphic. Clinical Significance Decreased cardiac output, possibly to life-threatening levels. May deteriorate into ventricular fibrillation.

Slide 13: 

Ventricular Tachycardia Treatment Perfusing patient: Administer oxygen and establish IV access. Consider immediate synchronized cardioversion starting at 100 J for hemodynamically unstable patients. Initially administer lidocaine 1.0–1.5 mg/kg IV. Administer repeat doses of lidocaine 0.5–0.75 mg/kg to the max dose of 3.0 mg/kg, or until VT is suppressed. Amiodarone 150–300 mg IV. Nonperfusing patient: Follow ventricular fibrillation protocol.

Pulseless Ventricular Tachycardia/Ventricular Fibrillation : 

18 Pulseless Ventricular Tachycardia/Ventricular Fibrillation First Impression: Sick or not sick? Primary Survey Unresponsive Open airway, give 2 breaths Give oxygen when available If no pulse, 30 compressions/2 breaths Attach AED or monitor/defibrillator Assess ECG rhythm Shockable? YES NO

Pulseless V-Tach/V-Fib : 

19 Pulseless V-Tach/V-Fib Shock (defibrillate) x 1 Resume CPR—5 cycles (about 2 min.) Without interrupting CPR, start IV/IO During CPR, give vasopressor Epinephrine 1 mg every 3-5 min OR Vasopressin 40 U x 1 in place of first or second epinephrine dose Assess ECG rhythm Shockable? YES Asystole? Go to asystole algorithm Electrical activity present? Check pulse No pulse, go to PEA algorithm Pulse present? Assess vital signs, Begin postresusciation care NO

Pulseless V-Tach/V-Fib : 

20 Pulseless V-Tach/V-Fib Shock (defibrillate) x 1 Resume CPR—5 cycles (about 2 minutes) During CPR, consider antiarrhythmic Amiodarone 300 mg IV/IO initial dose; consider repeat dose of 150 mg x 1 in 5 min OR Lidocaine 1-1.5 mg/kg IV/IO initial dose (if amiodarone not available), then 0.5-0.75 mg/kg prn every 5-10 min; max cumulative does 3 mg/kg Consider magnesium 1-2 g IV/IO for torsades de pointes Consider reversible causes of arrest SHOCKS Defibrillation Monophasic: 360 J all shocks AED: Per manufacturer Biphasic: Per manufacturer Biphasic unknown: 200 J initially, then same or higher as first shock

Pulseless V-Tach/V-Fib : 

21 Pulseless V-Tach/V-Fib CONSIDER CONTRIBUTING CAUSES Algorithm assumes scene safety has been assured, personal protective equipment is used, and previous step was unsuccessful.

Pulseless V-Tach/V-Fib : 

22 Pulseless V-Tach/V-Fib M – Myocardial Infarction-fibrinolytics? A – Acidosis-give O2, ensure adequate ventilation T – Tension pneumothorax—needle decompression C – Cardiac Tamponade—pericardiocentesis H – Hypovolemia—replace volume H – Hypoxia—give oxygen, ensure adequate ventilation H – Hypo/Hyperthermia—warm or cooling measures H – Hypokalemia—correct electrolyte abnormalties H – Hyperkalemia—correct electrolyte abnormalties E – Embolism (pulmonary)—anticoagulants? Surgery? D – Drug overdose—antidotes/specific therapy CONTRIBUTING CAUSES