Pulseless VF/VT Part 1
Pulseless
Ventricular Tachycardia and
Ventricular
Fibrillation
·
Ventricular
Tachycardia
·
Ventricular
Fibrillation
·
Torsades
de Pointe
Ventricular
Tachycardia characteristics
·
Rate: The atrial rate can't be determined. The
ventricular rate is 150 - 250. If the rate is below 150, it is called a slow VT
·
Rhythm: The rhythm is usually regular.
·
P Wave: Not usually visible.
·
PRI: There is no PRI, as the focus is
ventricular.
·
QRS: The QRS is wide and bizarre, usually 0.12
or greater. It is sometimes difficult to differentiate between QRS complexes
and T waves.
·
S-T Segment: Difficult, if not impossible to
see.
·
T Waves: Difficult to differentiate T waves from
QRS complexes
Ventricular Fibrillation Characteristics
·
Rate:
None
·
Rhythm:
None. The baseline is irregular and totally chaotic
·
P Wave:
None are visible.
·
PRI:
There is no PRI.
·
QRS:
None
·
S-T
Segment: None: None
·
T Waves:
None
Torsades de Pointe Characteristics
·
Rate: None
·
Rhythm: None. The baseline is irregular
beginning with small amplitude waveforms at the beginning which increase in
size and then decrease in amplitude once again
·
P Wave: None are visible.
·
PRI: There is no PRI.
·
QRS: None
·
S-T Segment: None
·
T Waves: None
Primary
Survey- ABCs
·
Assess
responsiveness and breathing
·
Active EMS
system and call for defibrillator/monitor
·
Check
pulse
·
Start CPR
beginning with chest compressions
Note:
The foundation of ACLS care is good BLS care, beginning with prompt
high-quality bystander CPR and, for VF/pulseless VT, attempted
defibrillation within minutes of collapse. For victims of
witnessed VF arrest, prompt bystander CPR and early defibrillation can significantly
increase the chance for survival to hospital discharge. In adults with a prolonged arrest,
shock delivery may be more successful after a period of effective
chest compressions.
Attempt Defibrillation
·
Deliver one shock at 120-200J biphasic or 360
monophasic
·
Follow defibrillation with a period of
uninterrupted CPR beginning with chest compressions
·
After 2 minutes (5 cycles of CPR), then recheck
the victim’s rhythm.
Note: When VF is present for more than a few
minutes, the myocardium is depleted of oxygen and metabolic substrates. A brief
period of chest compressions can deliver oxygen and energy substrates,
increasing the likelihood that a profusing rhythm will return after defibrillation
(elimination of VF).
If the provider is unaware of the effective dose range of
the device, the rescuer may use a dose of 200 J for the first shock and an
equal or higher shock dose for the second and subsequent shocks
If VF is initially terminated by a shock but then recurs
later in the arrest, deliver subsequent shocks at the previously successful
energy level
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