Ventricular Fibrillation Pulseless Ventricular Tachycardia

Section 4 - CARDIAC 4.08

VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA

• Precordial thump if witnessed and monitored.
• Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE!
• DEFIBRILLATION @ 120J-200J Biphasic.
• Initial defibrillation amount may depend on the patient. Size (small/large), medical history (healthy/cardiac history) or the amount of time the patient has been down. Witnessed arrest with bystander CPR may require less joules verses 5 minute down time may require more.
• Proceed to next step only if V-fib / pulseless V-Tach persists. If rhythm converts, follow appropriate Practice Parameters.
• Resume CPR immediately for 5 cycles. Check for pulse and rhythm change. Continue CPR (5 cycles) alternating with the following interventions:
• Ventilate (Intubation or BVM) using an inline EtCO2 device and establish IV or IO as able.
• DO NOT HYPERVENTILATE THE PATIENT.
• EPINEPHRINE 1:10,000 1 mg IV or IO. Repeat EPINEPHRINEevery 3 - 5 minutes of continued arrest. OR VASOPRESSIN 40 units IV or IO (once) and follow with EPINEPHRINEevery 3 - 5 minutes.
• DEFIBRILLATION @ 120J-300J Biphasic.
• LIDOCAINE 1 to 1.5 mg / kg IVP. May repeat every 5-10 minutes to a maximum of 3 mg/Kg.
• DEFIBRILLATION @ 120J-360J Biphasic.
• MAGNESIUM SULFATE 2 gm IVP only if suspected Polymorphic VT (Torsades de pointes). Hypomagnesemic state (chronic alcohol, diuretic use).
• DEFIBRILLATION @ 120J-360J Biphasic.
• SODIUM BICARBONATE 1 mEq/kg IVP if suspected, HYPERKALEMIA (e.g. dialysis patient), or Tricyclic antidepressant OD
• DEFIBRILLATION @ 120J-360J Biphasic.

If V-Fib converts to a pulse-producing non-heart block supraventricular rhythm, administer a LIDOCAINE bolus and drip 1-4 mg/min.

In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE boluses at 0.25 mg / kg every 3 minutes until maximum of 1.5 mg / kg administered.

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.