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Bradycardia

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Ventricular Fibrillation Management in the Adult

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  1. See Also
    1. Guidelines 2000 CPR and Emergency Cardiovascular Care
  2. Initial Management
    1. ABC Management
    2. CPR until Defibrillator available
      1. Consider 5 cycles CPR (2 min) before defibrillating
    3. Defibrillation options (single shock)
      1. Manual biphasic: Device specific dose (120-200 J) or
      2. Automated external Defibrillator (AED) or
      3. Monophasic 360 joules
    4. Secure cardiopulmonary access
      1. Continue Cardiopulmonary Resuscitation
      2. Hyperventilate with 100% oxygen
      3. Endotracheal Intubation
      4. Obtain Intravenous Access
    5. Cycles
      1. Perform 5 cycles of CPR (30:2) for total of 2 minutes
      2. Re-evaluate rhythm
        1. Electrical activity: Check for pulse
        2. Non-shockable rhythm: See Asystole, PEA
        3. Shockable rhythm (V. fib or V. Tach): Defibrillate
      3. Repeat Defibrillation as above after each cycle
      4. Administer medications once IV or IO access obtained
        1. Adrenergics: Epinephrine or Vasopressin
        2. Antiarrhythmics: Amiodarone or Lidocaine
  3. Management: Medications (after IV or IO access obtained)
    1. Adrenergic Medication for Persistent VF/VT
      1. Initial adrenergic medication
        1. Epinephrine 1 mg IV push (repeat every 3-5 min) or
        2. Vasopressin 40 Units IV for single, one time dose
      2. Subsequent adrenergic medication
        1. Vasopressin 40 U IV x1 dose if not given above or
        2. Epinephrine 1 mg IV push every 3-5 minutes
          1. Do not use for 20 minutes after Vasopressin
          2. Escalating doses (e.g. 5 mg) are harmful (Avoid)
    2. Consider Antiarrhythmic medication (choose 1)
      1. Amiodarone (preferred)
        1. Dose 1: 300 mg IV push
        2. Dose 2: 150 mg IV push
        3. Maximum cumulative dose: 2.2 grams in 24 hours
        4. Requires pressure support after use
      2. Lidocaine
        1. Dose 1: 1.0 to 1.5 mg/kg IV push
        2. Dose 2: 0.5 to 0.75 mg/kg IV push
        3. Maximum cumulative dose: 3 mg/kg
      3. Procainamide
        1. Dose: 30 mg/min
        2. Maximum cumulative dose: 17 mg/kg
    3. Consider adjunctive medications (specific indications)
      1. Magnesium Sulfate
        1. Dose: 1-2 g IV
        2. Indications
          1. Polymorphic VT (Torsades de Pointes)
          2. Suspected Hypomagnesemia
          3. Refractory Ventricular Fibrillation
      2. Sodium Bicarbonate
        1. Dose: 1 meq/kg IV
        2. Indications
          1. Preexisting Hyperkalemia
          2. Preexisting Metabolic Acidosis
          3. Tricyclic Antidepressant overdose
          4. Intubated with prolonged Resuscitation
  4. Management after return of spontaneous circulation
    1. Assess Vital Signs
    2. Support Airway and breathing
    3. Consider medications
      1. Infusion of Antiarrhythmic that converted rhythm
  5. References
    1. (2000) Circulation 102(Suppl I):86
    2. (2005) Circulation 112(Suppl 112):IV
    3. http://www.circulationaha.org

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