Cardiology In Critical Care

Lethal Dysrhythmias of the Heart

Ventricular Fibrillation or Pulseless V-tach (V-Fib, VF)

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Ventricular fibrillation or pulseless V-tach

A. Ventricles do not beat in any coordinated fashion, but twitch asynchronously and ineffectively; no ventricular contraction.

B. Clinical significance - There is no cardiac output. The patient becomes unconscious and perfusion to all parts ofthe body ceases.

C. Characteristics - rapid, repetitive, chaotic waves; no uniformity; cannot identify PQRST waves.


Fine V-Fib.



Coarse V-Fib.



1. Check pulse. If V-fib witnessed on monitor, give precordial thump.

2. CPR until defibriiiator is available.

3. Defibriliate with 200 joules.

4. If no response, defibrillate with 200-300 joules.

5. Defibrillate with up to 360 joules.

6. If patient is still in V-fib VT, Intubate at once. Start IV access. Give Epinephrine 1 mg. IV which should convert fine V-fib to coarse V-fib which is more susceptible to defibrillation.

7. If patient 61l not redcitated, Intubate and continue CPR.

8. Defibrillate with up to 360 joules.

9. Lidocaine 1-1.5 mg/kg. IV push. Repeat in 3-5 min. to total loading dose of 3mg/kg.

10. Defihrillate with up to 360joules.

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