Ventricular Fibrillation/Pulseless VT Algorithm (Flowchart)

«Flowchart»

Focus: basic CPR and defibrillation
Check responsiveness
Activate emergency response system
Call for defibrillator

Focus: Focus: Focus: Focus: Focus:
Check responsiveness Check responsiveness
Activate emergency response system Activate emergency response system
Call for defibrillator Call for defibrillator

Rhythm after first 3 shocks?

Rhythm after first 3 shocks? Rhythm after first 3 shocks?

Persistent or recurrent VF/VT?

Persistent or recurrent VF/VT? Persistent or recurrent VF/VT?

Secondary ABCD Survey

Focus: more advanced assessments and treatments

A Airway: place airway device as soon as possible

B Breathing: confirm airway device placement by exam plus confirmation device; purpose-made tube holders preferred

B Breathing: confirm effective oxygenation and ventilations

C Circulation: establish IV access

C Circulation: identify rhythm and monitor

C Circulation: administer drugs appropriate for rhythm and condition

D Differential Diagnosis: search for and treat identified reversible causes

Secondary ABCD Survey

Focus: more advanced assessments and treatments

A Airway: place airway device as soon as possible

B Breathing: confirm airway device placement by exam plus confirmation device; purpose-made tube holders preferred

B Breathing: confirm effective oxygenation and ventilations

C Circulation: establish IV access

C Circulation: identify rhythm and monitor

C Circulation: administer drugs appropriate for rhythm and condition

D Differential Diagnosis: search for and treat identified reversible causes

Secondary ABCD Survey

Focus: more advanced assessments and treatments

Focus: Focus: Focus:

A Airway: place airway device as soon as possible

A Airway:

B Breathing: confirm airway device placement by exam plus confirmation device; purpose-made tube holders preferred

B Breathing:

B Breathing: confirm effective oxygenation and ventilations

B Breathing:

C Circulation: establish IV access

C Circulation:

C Circulation: identify rhythm and monitor

C Circulation:

C Circulation: administer drugs appropriate for rhythm and condition

C Circulation:

D Differential Diagnosis: search for and treat identified reversible causes

D Differential Diagnosis:

Epinephrine: 1 mg IV push every 3-5 min; or
Vasopressin: 40U IV, single dose, 1 time only

Epinephrine: or or or
Vasopressin: single dose,

Consider antiarrhythmics:

Amiodarone (IIb)
Lidocaine (indeterminate)
Magnesium (IIb if hypomagnesemic state)
Procainamide (IIb for intermittent/recurrent VF/VT)
Consider buffers

Consider antiarrhythmics: Consider antiarrhythmics:

Amiodarone
Lidocaine
Magnesium
Procainamide
Consider buffers Consider buffers

Resume attempts to defibrillate

Resume attempts to defibrillate Resume attempts to defibrillate

A Airway: open the airway

B Breathing: provide positive-pressure ventilations

C Circulation: give chest compressions

D Defibrillation: assess for and shock VF/pulseless VT, up to 3 times (200J, 200-300J, 360J, or equivalent biphasic) if necessary

A Airway: open the airway

B Breathing: provide positive-pressure ventilations

C Circulation: give chest compressions

D Defibrillation: assess for and shock VF/pulseless VT, up to 3 times (200J, 200-300J, 360J, or equivalent biphasic) if necessary

A Airway: open the airway

A Airway:

B Breathing: provide positive-pressure ventilations

B Breathing:

C Circulation: give chest compressions

C Circulation:

D Defibrillation: assess for and shock VF/pulseless VT, up to 3 times (200J, 200-300J, 360J, or equivalent biphasic) if necessary

D Defibrillation: biphasic biphasic

Resume attempts to defibrillate
1 x 360 (or equivalentbiphasic) within 30-60 sec

Resume attempts to defibrillate
1 x 360 (or equivalent biphasic biphasic