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.
Treatment
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.