Key Changes in Case 3- VF/Pulseless VT: Persistent/Refractory/Recurrent
  • Prevent and minimize CPR interruptions
    • Advanced airway should not interrupt CPR
    • Interruptions should be 10 seconds or less
  • Defibrillation Energy settings will depend of the type of Defibrillator you are working with
  • First Shock Will be:
    • Monophasic 360 Joules
    • Biphasic Truncated 150-200 Joules
    • Biphasic Rectilinear 120 Joules
    • If Biphasic Type unknown use 200 Joules
  • Subsequent doses same or higher
  • Preferred route of Medications still is IV and IO. Endotracheal route is the very last resort
  • Medications Secondary to CPR include
    • Vasopressor's
      • Epinephrine-1mg IV/IO May repeat every 3-5 minutes
      • Or Vasopressin 40units IV/IO to replace first or second dose of epinephrine
    • Antiarrythmics
      • Amiodarone
      • Lidocaine
  • Emphasis is on QUALITY CPR following defibrillation. NO rhythm or pulse check until 2 minutes of CPR is completed.

 

Pulseless Arrest VT/VF Algorithm

start

  • BLS Algorithm: Call For Help-CPR
  • Give Oxygen when Available . Attach monitor/Defibrillator when available
  • Check Rhythm-Pulseless VT/VF
  • Give 1 Shock
    • Manual biphasic:device specific ( 120-200 J)
    • If type of biphasic unknown, use 200 J
    • Monophasic: 360 J
  • Resume CPR-Give 5 cycles of CPR (2 mins)
  • Check Rhythm-VT/VF- Shockable- Continue CPR while Defibrillator is charging
  • Give 1 Shock
    • Manual biphasic:device specific (Same as first shock or higher dose)
    • If type of biphasic unknown, use 200 J
    • Monophasic: 360 J
  • Resume CPR Immediately after the shock
  • When IV/IO available, give vasopressor during CPR
    (before or after the shock)
  • Epinephrine 1 mg IV/IO-Repeat every 3-5 min
  • May give 1 dose of vasopressin 40 units IV/IO to replace first or second dose of Epinephrine
  • Resume CPR-Give 5 cycles of CPR (2 mins)
  • Check Rhythm- Shockable- Continue CPR while Defibrillator is charging
  • Give 1 Shock
    • Manual biphasic:device specific ( 120-200 J)
    • If type of biphasic unknown, use 200 J
    • Monophasic: 360 J
  • Resume CPR Immediately after the shock
  • Consider Antiarrythmics: Give during CPR (before or after the shock)
  • Aminodarone(300 mgIV/IO once, then consider additional 150 mg IV/IO once) OR
  • Lidocaine (1 to 1.5mg/kg first dose, then 0.5 to .75mg/kg IV/IO maximum 3 dose or 3 mg/kg)
  • Consider Magnesium, loading dose 1 to 2 grams IV/IO for torsades De pointes
  • Resume CPR-Give 5 cycles of CPR(2 mins)