ADULT

V-Fib or Pulseless V-Tach / Wide Complex Tach

Algorithm

New UPDATED 10/1/2019

Initiate an organized approach to CPR with responders in designated positions

 

 

Coarse VF / Pulseless VT:

CPR --- 0 minute CPR

High Quality CPR without interruption unless pulse obtained

Witnessed Arrest - Consider passive ventilation for 6 min.

Un-witnessed Arrest - BVM / ETCO2 or Supraglottic airway unless:

ET indicated (Laryngeal edema from smoke inhalation)

Continue compression for approx. 2 min., then reassess

Place patient at 30 degrees - Semi-fowler if possible (ACCD)

Coarse VF / Pulseless VT:

SHOCK --- 2 minute Shock #1

Defibrillate once at Zoll (120j)  /  Philips (150j)  /  Lifepack (200j)

Fine VF = continued compressions

►IV/IO vascular access without interruption of CPR

Continue High Flow O2  / BVM with ETCO2 or Supraglotic Airway with ETCO2

Apply Automatic Chest Compression device when available before movement

Coarse VF / Pulseless VT:

SHOCK --- 4 minute Shock #2 

Defibrillate once at Zoll (120j)  /  Philips (150j)  /  Lifepack (200j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 5 minute Epi #1

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

Coarse VF / Pulseless VT:

SHOCK --- 6 minute Shock #3

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 7 minute Amio #1

Amiodarone 300 mg IV / IO, may repeat 150 mg IV / IO in 3-5 minutes

Maintain CPR

Coarse VF / Pulseless VT:

SHOCK --- 8 minute Shock #4

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 9 minute Epi #2

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

Coarse VF / Pulseless VT:

SHOCK --- 10 minute Shock #5

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT: 

INTUBATION --- 11 minute Intubation / Bicarb

Intubate with minimal interruption of CPR after 10 min of CPR

Sodium Bicarbonate 50 mL IV / IO

Maintain CPR

Coarse VF / Pulseless VT: 

SHOCK --- 12 minute Shock #6

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 13 minute Amio #2

Amiodarone 150 mg IV / IO

Maintain CPR

Coarse VF / Pulseless VT: 

SHOCK --- 14 minute Shock #7

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 15 minute Epi #3

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

Coarse VF / Pulseless VT: 

SHOCK --- 16 minute Shock #8

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT: 

SHOCK --- 18 minute Shock #8

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Coarse VF / Pulseless VT:

DRUG --- 19 minute Epi #4

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

Coarse VF / Pulseless VT: 

SHOCK --- 20 minute Shock #9

Defibrillate once at Zoll (200j)  /  Philips (150j)  /  Lifepack (360j)

Fine VF = continued compressions

Maintain CPR

Decision Point

1) Remain on scene and continue with treatment

2) Initiate transport to nearest ERC

3) Base Contact for further orders or pronouncement of patient in the field

RETURN OF SPONTANEOUS CIRCULATION (ROSC)

If prior to transport the pt develops a rhythm with pulse:
Make BHC for possible transport to Cardiovascular Receiving Center (CVRC)

 → Assess for and correct suspected:

Hypoxia, Hypovolemia, Hypoglycemia, and Hypothermia

D10 25 gm/250 mL (10% solution) IVPB / IO

If diabetic and hypoglycemia suspected:
(No D-stick, Non-Traumatic FA)

Epinephrine can be given with D10, there is no negative reaction

 

Interruption of chest compressions should always be held to a minimum.
Pads can be placed in the antero-lateral and antero-posterior positions;
For implanted pacemaker/defibrillator place pads to either side and not directly on top of the implanted device. For medication patch: remove patch, wipe area clean before attaching an electrode pad.

1:10,000 = 0.1mg/mL

1:1000 = 1mg/mL

Call

M: 949-769-1162

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