Ventricular Fibrillation Pulseless Ventricular Tachycardia

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Section 4 - CARDIAC

4.08 CARDIAC ARREST - VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA

Ventricular Fibrillation (VF) and Pulseless V-Tach (VT) focuses in the correction of the dysrhythmia into a pulse producing rhythm. Consider all possible reversible causes for cardiac arrest utilizing a national recommended mnemonic of “H’s and T’s”:

H’s T’s
Hypovolemia Tension Pneumothorax
Hypoxia Tamponade, cardiac
Hydrogen Ion (acidosis) Toxins or Tablets (overdose)
Hypo/hyperkalemia Thrombosis, pulmonary
Hypothermia Thrombosis, cardiac

In addition, also consider the following:

Hypoglycemia Trauma

When the Patient found in cardiac arrest:

  • Initiate BLS algorhythm with 5 cycles of high quality CPR (push hard/push fast)
    • Minimum of 100 compressions per minute, minimize interruptions
    • Compression rate of 30:2 for approximately 2 minutes
    • Depth of compression of at least 2 inches
    • Initiate the use of a mechanical compression device if available
  • Assist ventilations with OXYGEN @ 100% via BVM - DO NOT HYPERVENTILATE
  • Attach cardiac monitor – Evaluate the cardiac rhythm
    • VF/VT Present – deliver a DEFIBRILLATION 120-200j biphasic
  • Continue high quality CPR/Ventilations for 2 minutes
  • Establish intravenous access via IV or IO
  • Consider advanced airway procedure using supraglottic airway (king tube) or endotracheal intubation
    • Do not interrupt compressions to place an advanced airway
    • Confirm tube placement with capnography (a range 5-20 mmHg is indicative of low cardiac output)
  • Administer EPINEPHRINE 1:10,000 1 mg IV / IO – repeat every 3-5 minutes of arrest

OR

  • Administer VASOPRESSIN 40 units IV / IO – replaces the first or second dose of epinephrine
    • Vasopressin is a one-time dose
    • Do not stop CPR to administer medications
  • Reassess for circulation every two minutes
    • VF/VT Present – deliver a DEFIBRILLATION 300-360j biphasic
    • Subsequent shocks should be at the higher dose selected
  • Administer LIDOCAINE 1 to 1.5 mg/kg IVP. May repeat every 5-10 minutes to a maximum of 3 mg/Kg.
    • In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE gradually up to a full initial loading dose or until a maximum of 1.5 mg/kg administered.
    • If VF/VT converts to a pulse-producing non-heart block supraventricular rhythm, administer a LIDOCAINE DRIP 1-4 mg/min.
    • In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE DRIP at the lower 1-2 mg/min. MONITOR FOR SIGNS OF TOXICITY including seizure activity.
  • Administer MAGNESIUM SULFATE 2 gm IVP only if suspected Polymorphic VT (Torsades de pointes) or hypomagnesemic state (chronic alcohol, diuretic use)
  • Administer SODIUM BICARBONATE 1 mEq/kg IVP if suspected, HYPERKALEMIA (e.g. dialysis patient), or Tricyclic antidepressant OD

If patient combative post resuscitation, refer to ANALGESIA / SEDATION PARAMETER (2.04)

Deliver all Defibrillations at 360 Joules in any patient who has had an Automatic Implanted Cardioverter Defibrillator (AICD) shock. (Use Anterior/Posterior position if possible for Defibrillator Pads - Do not place pads over device).

  • Consider sedation in patient experiencing cardioversion or defibrillation by their own AICD.
  • Leave copy of ECG at ER on any patient with implanted device.

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