ALGORITHM for VF and PULSELESS VT
- See VT/QT Widening Asystole may resemble V. fib: if ? then consider conversion. Witnessed arrest Unwitnessed arrest | | check pulse-if No PULSE - if no pulse | | precordial thump only if | defibrillator not present | | | check pulse-if No pulse | |___________________________| | 100% O2 + Ventilate w/ Mask + Suction to Airway | CPR until Defibrillator arrives | Intubate as Soon as Posible | Check monitor for rhythm-if VF or VT | Defibrillate, 200 Joules | Defibrillate, 200-300 Joules | Defibrillate w/ upto 360 J | CPR if No Pulse | w/ no IV access then inject into ET tube: - Atropine, lidocaine, Epinephrine | Naloxone,isoproterenol, Bretylium | diluted in 10ml NS, - Injected into ET tube to bronchi by several | forceful lung inhalations Place a Central Line | Epinephrine, 1:10,000, 0.5-1.0 mg IV Push q 5' | Intubate as Soon as Posible | Defibrillate w/ upto 360 J | lidocaine - 1mg/kg IV push: (upto 3 mg/kg total dose) - if this is succesful, keep infusion at 2-4 mg/min; | Defibrillate w/ upto 360 J Bretylium | (consider bicarbonate: 1mEq/kg followed by 0.5 mg/kg q10') | Defibrillate w/ upto 360 J | Bretylium, - 10mg/kg IV push repeated q15-30 min; max=30mg/kg - if this is succesful, keep infusion at 1-4 mg/min; - or continue to try lidocaine: | Defibrillate w/ upto 360 J | Repeat lidocaine or Bretylium | Defibrillate w/ upto 360 J ---------------
Original Text by Clifford R. Wheeless, III, MD.