Pulseless VF/VT Part 2

Paddle Placement
· Avoids pacemakers and ICDs
· Avoid medication patches
· Avoid letting paddles touch
· Apex-anterior position
· Anterior-posterior position

Secondary Survey
• Intubate
• Secure airway device.
• IV access
• If IV access delayed- repeat defibrillation and continue CPR

Note: Once an advanced airway (eg, endotracheal tube, esophageal-tracheal combitube [Combitube], laryngeal mask airway [LMA]) is placed, 2 rescuers no longer deliver cycles of compressions interrupted with pauses for ventilation. Instead, the compressing rescuer should deliver 100 compressions per minute continuously, without pauses for ventilation. The rescuer delivering the ventilations should give 8 to 10 breaths per minute and should be careful to avoid delivering an excessive number of ventilations

Ways of Confirming ET Tube Placement

•      Direct cord visualization

•      End-tidal CO2 monitor

Purple- problem

Yellow- yes

Tan- think about it

•      Bilateral breath sounds

•      CXR

•      Continuous waveform capnography

Note: Providers should observe a persistent capnographic waveform with ventilation to confirm and monitor endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any patient transfer to reduce the risk of unrecognized tube misplacement or displacement.

Continuous Waveform Capnography

·         Persistently low PETCO2 values (<10 mm Hg) during CPR in intubated patients suggest that ROSC is unlikely

·         If PETCO2 is <10 mm Hg, it is reasonable to consider trying to improve CPR quality by optimizing chest compression parameters

Note:  Although a PETCO2 value of <10 mm Hg in intubated patients indicates that cardiac output is inadequate to achieve ROSC, a specific target PETCO2 value that optimizes the chance of ROSC has not been established. Monitoring PETCO2 trends during CPR has the potential to guide individual optimization of compression depth and rate and to detect fatigue in the provider performing compressions