Refractory V Fib Acls

Ventricular fibrillation is the most common arrhythmia in cardiac arrest patients.

Refractory v fib acls. The result is these muscles quivering rather than contracting in rhythm. Management of refractory ventricular fibrillation rachael scott pharmd pgy2 critical care pharmacy resident pharmacy grand rounds january 22 2019 2018 mfmer slide 2 patient case code 45 response ab is a 30 year old male pod 3 from. Ventricular fibrillation v fib is a common cause of out of hospital cardiac arrest. Logistics of using esmolol for refractory ventricular fibrillation when you get that call patched in of a refractory vf patient coming in to your ed premix 300mg of amiodorane 500micrograms kg of esmolol and prepare for dual defibrillation by bringing two defibrillators to the bedside turned on pre charged and with the pads ready to be placed on the patient on arrival.

After 2 minutes of cpr the rhythm should be reassessed during v fib treatment. Continued vf calls for another shock followed by good cpr once again for 2 minutes. The video below shows an example of what ventricular fibrillation will look like when you see it on the defibrillator monitor. If the patient is in vtach or vfib this is a shockable rhythm apply defibrillator pads or paddles and shock the patient with 120 200 joules on a biphasic defibrillator or 360 joules using a monophasic.

Ventricular fibrillation is a shockable rhythms and is treated in a similarly to ventricular tachycardia vt. But it continues to be the primary antiarrhythmic medication for the treatment of ventricular fibrillation and ventricular tachycardia within the cardiac arrest algorithm. After 2 minutes of cpr check rhythm. Within acls amiodarone is used for its antiarrhythmic properties and is effective for the treatment of supraventricular arrhythmias and ventricular arrhythmias.

This 2018 american heart association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock refractory. The treatment of such an arrhythmia is included in the acls pulseless arrest algorithm. Refractory ventricular fibrillation rvf is a life threatening cardiac arrhythmia unresponsive to traditional methods of defibrillation and advanced cardiovascular life support acls. The only method by which to confirm this arrhythmia is by electrocardiography.

Ventricular fibrillation is always pulseless and must be confirmed by ekg or defibrillator monitor. Acls protocol n 22 sympathetic blockade. Continue high quality cpr for 2 minutes while others are attempting to establish iv or io access. On the monitor v fib will look like a frenetically disorganized wavy line.

Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation pulseless ventricular tachycardia cardiac arrest. Defibrillation is the treatment of choice and should occur as soon as possible.