Ventricular Fibrillation (VF) / Pulseless Ventricular ...



ACLS Summary Revised January 2017

Epinephrine: 1 mg (10,000 concentration) q-3 – 5 minutes (no max dosage) used in cardiac arrest for the following rhythms: Asystole, Ventricular Fibrillation (VF), Pulseless Electrical Activity (PEA), Ventricular Tachycardia (VT) without a pulse.

A = Amiodarone: (Cordarone) V-Fib/pulseless VT: Dose 300 mg, (q-5 minutes) repeat 150 mg

Amiodarone: Stable VT or Stable SVT (patient with a pulse) – 150 mg over 10 minutes

A = Atropine: 0.5mg for symptomatic Bradycardia (total dose of 3 mg) (This medication may be beneficial in the presence of AV nodal block or ventricular asystole). Will not be effective for infranodal (Mobitz type II) block, or Third degree heart blocks with a ventricular escape complexes (wide QRS complex >120ms).

A = Adenosine: (adenocard) Stable SVT or Monomorphic VT 6mg, repeat dose of 12 mg. Should not be used for wide irregular rhythms. (note: this medication may cause paradoxical increase in the ventricular response).

A = Aspirin: oral dose in the event of an ACS is 160 – 325 mg

Dopamine Drip : (intropin) for hypotension and/or refractory symptomatic Bradycardia 2 – 10 mcg/kg/min

Magnesium Sulfate: 1-2 g IV/IO in 10 mL (eg, D5W, NS) over 5-20 minutes

Epinephrine Drip: 2 – 10 mcg/min

Capnography:

NOTE: In cardiac arrest the capnography or (PETCO2) needs to be greater than 10 mmHg, if 0.20 sec or 200 ms (5 little boxes or 1 large box, (Rhythm is Regular)

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2nd degree HB Type I (Wenckebach) – PRI progressively gets long then drops a beat. (Rhythm is Irregular)

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2nd degree HB Type II – PRI is constant, with extra p-waves or p-waves without QRS complexes (Rhythm is regular and/or irregular) look for 2:1 conduction

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3rd degree HB (CHB) - No relationship between P and QRS (Ventricular Rhythm is regular) P waves are dancing

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Symptomatic Bradycardia treatment options:

1. Atropine 0.5 mg

2. Transcutaneous Pacing (TCP)

3. Dopamine Drip 2-10 mcg/kg/min

4. Epinephrine Drip 2-10 mcg/min

Tachycardia - Heart rate > 160/minute

Ventricular Fibrillation (VF) (1)

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Monomorphic Ventricular Tachycardia (VT) (2)

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Supraventricular Tachycardia (SVT) (3)

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Atrial Fibrillation with RVR (4)

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Reversible Causes: H’s & T’s

Hypovolemia –Hypoxia - Hypothermia

Hydrogen Ion (acidosis) - Hypo-/hyperkalemia

Tension Pneumothorax - Tamponade, Cardiac

Toxins-Thrombosis- Pulmonary Thrombosis, Coronary

Pacing Technique

1. Position pacing electrodes on chest per package instructions

2. Apply limb leads to appropriate position on the patient

3. Turn on pacer

4. Set demand rate to approximately 70-80/minute

5. Set current (mA) output as follows for Bradycardia: increase current from minimum setting until consistent capture is achieved (characterized by a widening QRS and a broad T wave after each pacer spike)

6. Evaluate mechanical capture (assessing peripheral pulses).

7. Evaluate patient BP.

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Bill’s EKG Criteria Summary

|Rhythm |Rate – range |Regular/Irregular |Criteria |

|NSR |60-100/minute |Regular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

|Sinus Bradycardia |< 60/minute |Regular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

|Sinus Tachycardia |100-160/minute |Regular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

|Sinus Arrhythmia |60-100/minute |Irregular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

| | | |Caused by intrathoracic pressure |

| | | |changes |

|Sinus Block (SA) |60-100/minute |Irregular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

| | | |A block or a pause between 2 normal|

| | | |beats, does not disrupt the normal |

| | | |rhythm |

|Sinus Arrest |60-100/minute |Irregular |1 p-wave for each QRS |

| | | |PRI- 0.12 - .20 sec |

| | | |A block or a pause between 2 normal|

| | | |beats, does disrupt the normal |

| | | |rhythm |

|Atrial Flutter |Ventricular Rate varies |regular/Irregular |Description of a sawtooth pattern |

| | | |with p-waves |

|Atrial Fibrillation |Ventricular Rate varies |Irregular |No identifiable p-waves |

|SVT |160/min |Regular |No identifiable p-waves, which are |

| | | |buried inside the T-wave, usually a|

| | | |narrow QRS complex |

|Wandering Atrial Pacemaker (WAP) |60-100/minute |Irregular |3 different morphology or shapes of|

| | | |P-waves |

|Junctional Rhythm |40-60/minute |Regular |P-waves are either absent, inverted|

| | | |or behind the QRS complex, Narrow |

| | | |QRS complex |

|Accelerated Junctional |60-100/minute |Regular |P-waves are either absent, inverted|

| | | |or behind the QRS complex, Narrow |

| | | |QRS complex |

| | | | |

| | | | |

|Junctional Tachycardia |100/minute |Regular |P-waves are either absent, inverted|

| | | |or behind the QRS complex. Narrow |

| | | |QRS complex |

|1st Degree HB | .20 sec or 5 little |

| | | |boxes or 1 large box |

|2nd Degree HB Type I | ................
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