Download VF / Pulseless VT

A. Jafari . MD
Assistant Professor of emergency
medicine
Zanjan University of medical science
• Four rhythms produce pulseless cardiac arrest:
• Ventricular fibrillation (VF).
• rapid ventricular tachycardia (VT).
• Pulseless electrical activity (PEA).
• Asystole.
VF
V.tach
PEA
Asystole
Do not Forget ABCD
• A: Insert an advanced airway.
• B: PPV, Pulseoximetry.
• C: Continuing chest compression, Obtaining
certain IV root, Fluid & drug administration.
• D: Differential diagnosis.
• Endotracheal route:
• What drugs? Lidocaine, Epinephrine, Atropine,
Naloxone, and Vasopressin.
• Results in lower blood concentrations than the
same dose given intravascularly.
• The optimal endotracheal dose of most drugs is
unknown, but typically 2 to 2.5 times
recommended IV dose.
• should dilute recommended dose in 5 to 10 mL of
water or normal saline.
• VF / Pulseless VT:
• immediate bystander CPR with minimal interruption
in chest compressions and defibrillation as soon as
possible.
• witnessed arrest + defibrillator on-site:
Deliver 2 rescue breath.
Check pulse. If no pulse;
Turn on the defibrillator, place paddles, and check
the rhythm.
If VF/pulseless VT is present ,deliver 1 shock &
immediately resume CPR.
• Unwitness arrest in out-of-hospital setting:
• Give 5 cycles of CPR before attempting
defibrillation.(??)
Management of VF / pulseless VT:
• Deliver 1 shock.
biphasic: 120-200 j
Monophasic: 360 j
• Then resume CPR immediately and continue for 2 min then
check rhythm.
• When a rhythm check reveals VF/VT, rescuers should
provide CPR while the defibrillator charges.
• Recall H’s & T’s.
• Hypovolemia.
• Toxin.
• Hypoxia.
• Tamponade.
• Hydrogen ion.
• T.P
• Hypo/Hyperkalemia.
• Thrombosis (coronary
or pulmonary).
• Hypothermia.
• If VF/VT persists after 1 or 2 shocks plus CPR, give
Epinephrine 1mg q3-5 min.
• When VF/pulseless VT persists after 2-3 shocks plus
CPR and vasopressor, consider antiarrhythmic.
• Rhythm checks should be brief, and pulse checks
should generally be performed only if an organized
rhythm is observed.
• Continue shock-CPR(2 min) sequence + antiarrhythmic.
• Amiodarone 300 mg IV/IO bolus.
150 mg after 10-15 min.
Repeat amiodarone
• Lidocaine 1-1.5 mg/kg first dose then 0.5- 0.75 mg/kg.
maximum 3 doses or 3 mg/kg with 5-10 min interval.
• Consider MgSO4 for torsades de pointes. Loading dose 1-2
gr in 10cc DW5% IV/IO.
Fibrinolysis
• Ongoing CPR is not an absolute contraindication to
fibrinolysis.
• Fibrinolytic therapy should not be routinely used in cardiac
arrest.
• It may be considered on a case-by-case basis when PTE (MI)
is suspected.
Pacing in Arrest
• Several randomized controlled trials failed to show
benefit from attempted pacing for asystole.
• At this time use of pacing for Pts with asystolic
cardiac arrest is not recommended.
Precordial Thump
• It can deteriorate in cardiac rhythm
• It may be considered for
• termination of
– Witnessed
– monitored
– unstable ventricular tachyarrhythmias
– when a defibrillator is not immediately ready for
use.
Sodium Bicarbonate
• It’s routine use is not recommended
• Can be beneficial:
– Preexisting metabolic acidosis
– Hyperkalemia
– TCA overdose