430 ACLS STUDY GUIDE

Pulseless Ventricular Tachycardia/Ventricular Fibrillation

Algorithm (Figure 8-5)
Updated! Barbara Aehlert’s unique treatment
algorithms are user friendly and easy to
Pulseless VT/VF Algorithm remember – and all have been completely
revised to reflect the 2005 emergency cardiac
First Impression: Sick or not sick?
Primary survey care guidelines, ensuring you are learning the
Unresponsive? most up-to-date information available.
Open airway, give 2 breaths
Give oxygen when available
If no pulse, 30 compressions/2 breaths Assess ECG rhythm
Attach AED or monitor/defibrillator Shockable?

YES

Shock (defibrillate)  1 SHOCKS

Resume CPR—5 cycles (about 2 minutes) Defibrillation
Without interrupting CPR, start IV/IO • Monophasic: 360J all shocks
During CPR, give vasopressor • AED: Per manufacturer
Epinephrine 1 mg every 3-5 min • Biphasic: Per manufacturer
NO OR • Biphasic unknown: 200J
Vasopressin 40 U  1 in place initially, then same or higher
of first or second epinephrine dose as first shock
Asystole?
Go to asystole algorithm
Electrical activity present? REVERSIBLE CAUSES
Check pulse
No pulse, go to PEA algorithm Assess ECG rhythm • Pulmonary embolism—
Pulse present? Assess vital signs, NO anticoagulants? surgery?
Shockable?
begin postresuscitation care • Acidosis—give oxygen,
ensure adequate ventilation
• Tension pneumothorax—
YES needle decompression
REASSESS/MONITOR • Cardiac tamponade—
pericardiocentesis
• Airway
Shock (defibrillate)  1 • Hypovolemia—replace
• Oxygenation/ventilation
Resume CPR—5 cycles (about 2 minutes) volume
• Paddle/pad position/contact
During CPR, consider antiarrhythmic • Hypoxia—give oxygen,
• Effectiveness of CPR
Amiodarone 300 mg IV/IO initial dose; consider ensure adequate ventilation
• No O2 flowing over patient
repeat dose of 150 mg  1 in 5 min • Heat/cold—cooling/warming
during shocks
OR measures
Attempt/verify:
Lidocaine 1-1.5 mg/kg IV/IO initial dose • Hypo—hyperkalemia (and
• Advanced airway placement
(if amiodarone not available), other electrolytes)— correct
• Vascular access
then 0.5-0.75 mg/kg prn every 5-10 min; electrolyte abnormalities
Monitor and treat:
max cumulative dose 3 mg/kg • Myocardial infarction—
• Glucose
Consider magnesium 1-2 g IV/IO fibrinolytics?
• Electrolytes
for torsades de pointes • Drug overdose/accidents—
• Temperature
Consider reversible causes of arrest antidote/specific therapy
• CO2

Algorithm assumes scene safety has been assured, personal protective

equipment is used, no signs of obvious death or presence
of do not resuscitate order, and previous step was unsuccessful

Figure 8-5 • Pulseless VT/VF algorithm.

Ch08-A4695_417-484.indd 430 6/30/06 9:07:24 AM