Acute Care 12: Ventricular Fibrillation/
Pulseless Ventricular Tachycardia Algorithm
| Assess
responsiveness/breathing. Activate emergency response system Get AED or Monitor/defibrillator  |
|
Check for pulse (no more than 10 seconds) If no pulse, begin CPR |
| As soon as
defibrillator is available: Defibrillate 360 J if using monophasic defibrillator. For biphasic energy levels, refer to defibrillator specifications; if unknown, use maximal energy setting. PEDS: In children, use 2 Joules/kg. |
| Resume CPR for 5
cycles. Secure airway. Obtain IV/IO access; then reassess pulse and rhythm. |
|
Persistent or
recurrent VF/VT
|
Return of
spontaneous
circulation |
Pulseless electrical
activity (PEA) |
Asystole
|
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| Epinephrine
1 mg
IV push; repeat every 3 to 5 min (PEDS: 0.01 mg/kg IV/IO or 0.1 mg/kg ET)) Vasopressin 40 Units IV/IO may be used in place of first or second dose of epinephrine (adults only).  |
Assess
vital signs. Support airway. Support breathing. Provide medications appropriate for blood pressure, heart rate, and rhythm. Consider cooling patient to 32°C-34°C (90°F - 93°F). |
Go
to PEA Algorithm |
Go
to Asystole Algorithm |
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| Defibrillate
360 J or equivalent biphasic energy level
(if unknown, use maximum energy level) (PEDS: 4 Joules/kg in children). Resume CPR for 5 cycles then reassess pulse and rhythm. |
|
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| Amiodarone
300 mg IV/IO push. May repeat at 150 mg IV/IO push in 3 to 5 minutes. (Class IIb) (PEDS: 5 mg/kg) |
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| Magnesium
sulfate 1 to 2 g IV (2 to 4 mL of a 50% solution) diluted in 10 mL of D5W used in torsades de pointes or hypomagnesemia only. PEDS: In children use 25 to 50 mg/kg. (Class IIb) |
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| Repeat
defibrillation at maximal energy levels. Do 5 cycles of CPR and reassess. PEDS: ≥ 4 Joules/kg up to a 10 Joules/kg or adult dose. |
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| If
patient remains in VF/VT, sequence follows: drug intervention, defibrillation, 5 cycles of CPR, reassess. |
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