Ventricular Fibrillation (VF)/ Pulseless Ventricular Tachycardia (PVT) Algorithm

Please Shock-Shock-Shock, EVerybody Shock, And Let's Make Patients Better

1. Please Precordial Thump
   May be performed immediately after determining pulselessness in a witnessed arrest with no defibrillator immediately available. Check pulse after thump.
   
2. Shock 200J**Or equivalent biphasic energy level.
   If VF or VT is shown on monitor, shock immediately, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm.
   
3. Shock 200-300J**Or equivalent biphasic energy level.
   If VF or VT persists on monitor, shock immediately, do not check pulse, do not continue CPR, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm.
   
4. Shock 360J**Or equivalent biphasic energy level.
   If VF or VT persists, shock immediately.
   NOTE: Do not continue with this algorithm if an intervention results in the return of spontaneous circulation.
5. Everybody Epinephrine
   1 mg IV q3-5 min.
   OR Vasopressin
   Vasopressin 40 U IV, one time dose. (wait 10-20 minutes before starting epi)
   
6. Shock drug-shock-drug-shock
   When giving med's, do so in a drug-shock-drug-shock sequence. Continue CPR while giving meds, and shock within 30-60 seconds. Evaluate the rhythm and check for a pulse in the period immediately after shocking.
   NOTE: If VF/PVT persists, "CONSIDER" antiarrhythmics and sodium bicarb.
   
7. And Amiodarone (first Choice)
   300mg IV push. May repeat once at 150mg in 3-5 min. (max. cumulative dose: 2.2g IV/24hrs.)
   CAUTION: Using more than one antiarrhythmic may result in pro-arrhythmic drug-drug interactions.
   
8. Let's Lidocaine
   1.0-1.5 mg/kg IV. May repeat in 3-5 min. (max. loading dose: 3 mg/kg)
   
9. Make Magnesium Sulphate
   1-2 g IV (2 min. push) for suspected hypomagnesemia or torsades de pointes.
   
10. Patients Procainamide
    30 mg/min up to 17mg/kg "acceptable but not recommended" in refractoryVF
    
11. Better Bicarb
    1 mEq/kg IV for preexisting hyperkalemia, bicarb-responsive acidosis, some drug overdoses, protracted code (intubated), or return of spontaneous circulation after long code with effective ventilation.
    

A Little about Biphasic Defibrillators