ADULT
V-Fib or Pulseless V-Tach / Wide Complex Tach
Algorithm
New UPDATED 10/1/2021
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)
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Continue compression for approx. 2 min., then reassess
Place patient at 30 degrees - Semi-fowler if possible (ACCD)
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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
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Continue High Flow O2 / BVM with ETCO2 or Supraglotic Airway with ETCO2
Apply Automatic Chest Compression device when available before movement
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Coarse VF / Pulseless VT:
SHOCK --- 4 minute Shock #2
►Defibrillate once at Zoll (150j) / Philips (150j) / Lifepack (200j)
Fine VF = continued compressions
Maintain CPR
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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
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Coarse VF / Pulseless VT:
SHOCK --- 6 minute Shock #3
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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Coarse VF / Pulseless VT:
DRUG --- 7 minute Amio/Lido #1
►Amiodarone 300 mg IV / IO, may repeat 150 mg IV / IO in 3-5 minutes
or
►Lidocaine 1mg/kg IV / IO, may repeat 0.5 mg/kg IV / IO in 3-5 minutes
Maintain CPR
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Coarse VF / Pulseless VT:
SHOCK --- 8 minute Shock #4
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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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
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Coarse VF / Pulseless VT:
SHOCK --- 10 minute Shock #5
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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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
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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/Lido #2
►Amiodarone 150 mg IV / IO
or
►Lidocaine 0.5 mg/kg IV / IO
Maintain CPR
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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
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Coarse VF / Pulseless VT:
SHOCK --- 16 minute Shock #8
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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Coarse VF / Pulseless VT:
SHOCK --- 18 minute Shock #8
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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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
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Coarse VF / Pulseless VT:
SHOCK --- 20 minute Shock #9
►Defibrillate once at Zoll (200j) / Philips (150j) / Lifepack (360j)
Fine VF = continued compressions
Maintain CPR
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Decision Point
1) Remain on scene and continue with treatment (Refer to 2 or 3 after 30 min.)
2) Initiate transport to nearest ERC
3) Base Contact for further orders or pronouncement of patient in the field
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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
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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