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Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (VT) [ALS]
Terms in this set (35)
Unconscious, pulseless patient with ventricular fibrillation (VF) or ventricular tachycardia (VT) on ECG and
where the cardiac arrest may be witnessed or unwitnessed
EMS Witnessed Arrest
In keeping with the time-to-defibrillation focus of the 2005 AHA
Guidelines, a "Witnessed Cardiac Arrest" is one where the patient's collapse and pulselessness
occur in the presence of the EMT and a defibrillator shock can be delivered within 30 seconds
Other cardiac arrest situations where a defibrillator shock cannot be
delivered within 30 seconds
Check the pulse
If Unwitnessed Cardiac Arrest, begin CPR using the current sequence recommended by the
American Heart Association and deliver about 5 cycles or 2 minutes of CPR while obtaining and
If Witnessed Cardiac Arrest, proceed to immediate defibrillation.
Immediately apply "quick-look" paddles or "hands-free" electrodes. Use adult standard paddles/pads for
all patients > 1 year old (10 kg.) and ensure adequate spacing (>3cm.) between paddles/pads. Use
infant paddles/pads on patients < 1 year old. Anterior/posterior placement where possible is preferred.
Identify VF or VT. Changing the location of the electrodes may reveal VF that first appears to be asystole.
Record initial ECG rhythm and attempted defibrillations; attach copies of the rhythm strips to the
hospital copy of theRI EMS Ambulance Run Report, as part of required documentation.
Adult patients: Check pulse and identify rhythm. If VF/VT persists, defibrillate at 360 joules
monophasic or manufacturer's biphasic setting.
Immediately resume CPR and perform any additional defibrillations per current AHA guidelines.
Check rhythm after performance of cycles of defibrillation and CPR according to AHA guidelines.
If VF/VT is converted to another perfusing rhythm check pulse, reassess the patient, and follow all
If VF/VT persists, continue treatment as indicated below.
Begin or continue CPR sequence following current AHA guidelines
DO NOT INTERRUPT CPR FOR MORE THAN 5 SECONDS EXCEPT FOR A
MAXIMUM OF 30 SECONDS TO DEFIBRILLATE, MOVE THE PATIENT OR PERFORM
ADVANCED AIRWAY TECHNIQUES WHEN INDICATED. IF SAFE PATIENT
TRANSPORT WILL CAUSE DELAYS, PERFORM ALS INTERVENTIONS PRIOR TO
PATIENT MOVMENT IF POSSIBLE.
Place the patient on a cardiac monitor, if not previously done.
Observe and record the initial ECG rhythm, and any rhythm change
Attach a copy of the initial rhythm strip to the hospital copy of the RI EMS Ambulance Run Report.
Establish at least one IV of NORMAL SALINE or LACTATED RINGER'S solution to run at KVO rate.
Consider an advanced airway as indicated in the Airway Management and Respiratory Support
Whenever possible, ventilate the patient using high-concentration oxygen.
Adult patients: Administer EPINEPHRINE 1:10,000 1.0 mg IV push. Repeat every 3-5 minutes if
VF/pulseless VT persists.
Continue CPR for 30-60 seconds after administration of EPINEPHRINE.
Adult patients: Defibrillate at 360 joules (maximum energy) monophasic or at manufacturer's biphasic
If VF/VT persists, continue sequence of EPINEPHRINE administration, then defibrillation every 3-5
If VF/VT persists, and while continuing EPINEPHRINE/defibrillation sequence, administer
AMIODARONE or LIDOCAINE HCL as indicated below.
Adult patients: administer AMIODARONE 300 mg IV bolus once.
If VF/VT is converted to a perfusing rhythm, contact Medical Control for permission to administer
AMIODARONE. A loading dose may be considered if not already given with careful attention to the
risk of side effects.
Administer AMIODARONE by IV Infusion Pump Only at a rate as directed by Medical Control (typically
1- 15 mg/min - faster rates are associated with a higher risk of hypotension). 150mg over 10mins
For certain conditions, Medical Control may authorize administration of SODIUM BICARBONATE
1 mEq/kg IV push, followed by 0.5 mEq/kg IV push every 10 minutes.
EMT-Ps ONLY: For Torsades de Pointes, consider administration of MAGNESIUM SULFATE 1 gram
IV. Dose may be repeated once (max. dosage 2 grams).
Transport the patient without delay to the nearest Hospital Emergency Facility.
With authorization from Medical Control, consider administration of GLUCAGON if beta-blocker
overdose is suspected.
EMT-Ps, or EMT-Cs with authorization from Medical Control, may consider administration of
CALCIUM CHLORIDE, 1g IV, if hyperkalemia or calcium channel blocker overdose are suspected.
Document all incident information by completing the RI EMS Ambulance Run Report.
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 44 study
Neonatal Care Chapter 42
Pediatrics ch 43
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