Ventricular Fibrillation Pulseless Ventricular Tachycardia - Revision history

Mfrdmanager at 13:40, 13 November 2020

2020-11-13T13:40:50Z

Mfrdmanager: /* When the Patient found in cardiac arrest: */

2018-03-21T21:13:09Z

‎When the Patient found in cardiac arrest:

Mfrdmanager: /* When the Patient found in cardiac arrest: */

2018-03-21T21:12:35Z

‎When the Patient found in cardiac arrest:

Mfrdmanager: Protected "Ventricular Fibrillation Pulseless Ventricular Tachycardia" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

2018-02-10T14:04:47Z

Protected "Ventricular Fibrillation Pulseless Ventricular Tachycardia" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

Mfrdmanager: Created page with "==Section 4 - CARDIAC== ===4.08 CARDIAC ARREST - VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA=== Ventricular Fibrillation (VF) and Pulseless V-Tach (VT) focus..."

2018-02-10T14:04:39Z

Created page with "==Section 4 - CARDIAC== ===4.08 CARDIAC ARREST - VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA=== Ventricular Fibrillation (VF) and Pulseless V-Tach (VT) focus..."

New page

==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”:

{| class="wikitable"
|-
! 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:
{| class="wikitable"
|-
| 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 [[Adrenergics|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
:'''OR'''
* Administer [[Hormones Vitamins|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
''If after 3 attempts at defibrillation and patient is still presenting VF, consider using double sequential defibrillation for subsequent shocks at 720j biphasic. If two manual monitors are not available, use one monitor and one AED even though they will not be able to deliver full 720j. (using [https://www.youtube.com/watch?v=Ov-BBUhKdJU double sequential defibrillation])
* Administer antidysrhythmic medication:
** [[Antiarrhythmics|AMIODARONE]] 300 mg IVP, IO.
** May repeat second dose [[Antiarrhythmics|AMIODARONE]] (if needed) 150 mg IV, IO in 3-5 minutes.
*** Maximum dose 450 mg.
:'''OR'''
* Administer [[Antiarrhythmics|LIDOCAINE]] 1 to 1.5 mg/kg IVP, IO. 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 [[Antiarrhythmics|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 [[Antiarrhythmics|LIDOCAINE]] DRIP 1-4 mg/min.
** In patients over age 70 or in those with known hepatic disease, administer [[Antiarrhythmics|LIDOCAINE]] DRIP at the lower 1-2 mg/min. MONITOR FOR SIGNS OF TOXICITY including seizure activity.
* Administer [[Electrolytes|MAGNESIUM SULFATE]] 2 gm IVP only if suspected Polymorphic VT (Torsades de pointes) or hypomagnesemic state (chronic alcohol, diuretic use)
* Administer [[Electrolytes|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 and Sedation|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.

[[File:Adult_Cardiac_Arrest_Flowchart.jpg|500px]]

[[Category:Cardiac|0408]]

@@ Line 40: / Line 40: @@
 ** 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 [[Adrenergics|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
+* Administer [[Epinephrine|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
 ** Do not stop CPR to administer medications
 * Reassess for circulation every two minutes
@@ Line 47: / Line 50: @@
 ''If after 3 attempts at defibrillation and patient is still presenting VF, consider using double sequential defibrillation for subsequent shocks at 720j biphasic.  If two manual monitors are not available, use one monitor and one AED even though they will not be able to deliver full 720j.  (using [https://www.youtube.com/watch?v=Ov-BBUhKdJU double sequential defibrillation])
 * Administer antidysrhythmic medication:
-* Administer [[Antiarrhythmics|LIDOCAINE]] 1 to 1.5 mg/kg IVP, IO. May repeat every 5-10 minutes to a maximum of 3 mg/Kg.
+** [[Amiodarone|AMIODARONE]] 300 mg IVP, IO.
-** In patients over age 70 or in those with known hepatic disease, administer [[Antiarrhythmics|LIDOCAINE]] gradually up to a full initial loading dose or until a maximum of 1.5 mg/kg administered.
+** May repeat second dose [[Amiodarone|AMIODARONE]] (if needed) 150 mg IV, IO in 3-5 minutes.
-** If VF/VT converts to a pulse-producing non-heart block supraventricular rhythm, administer a [[Antiarrhythmics|LIDOCAINE]] DRIP 1-4 mg/min.
+*** Maximum dose 450 mg.
-** In patients over age 70 or in those with known hepatic disease, administer [[Antiarrhythmics|LIDOCAINE]] DRIP at the lower 1-2 mg/min. MONITOR FOR SIGNS OF TOXICITY including seizure activity.
+:'''OR'''
-* Administer [[Electrolytes|MAGNESIUM SULFATE]] 2 gm IVP only if suspected Polymorphic VT (Torsades de pointes) or hypomagnesemic state (chronic alcohol, diuretic use)
+* Administer [[Lidocaine|LIDOCAINE]] 1 to 1.5 mg/kg IVP, IO. May repeat every 5-10 minutes to a maximum of 3 mg/Kg.
-* Administer [[Electrolytes|SODIUM BICARBONATE]] 1 mEq/kg IVP if suspected, HYPERKALEMIA (e.g. dialysis patient), or Tricyclic antidepressant OD
+** In patients over age 70 or in those with known hepatic disease, administer [[Lidocaine|LIDOCAINE]] gradually up to a full initial loading dose or until a maximum of 1.5 mg/kg administered.
 '''If patient combative post resuscitation, refer to [[Analgesia and Sedation|ANALGESIA / SEDATION PARAMETER (2.04)]]'''

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