Ventricular Tachycardia Algorithm

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Persistent VF/VT after defibrillation

Secondary ABCD survey

A Airway – place airway device ASAP (100% O2)

B Breathing – Confirm placement of airway device (by exam and confirmation device)

B Breathing – Secure airway device

B Breathing – Confirm effective oxygenation and ventilation

C Circulation – Establish IV access 0.9%NaCl at 200 ml/hr

C Circulation – Identify rhythm--->monitor

C Circulation – administer appropriate drugs for the rhythm & condition

D Differential diagnosis – search for and treat identified reversible causes

EPINEPHRINE 1 mg IVP (or equivalent ET) Dosage: 1.0 mg IV every 3-5 mins.

OR

VASOPRESSIN: Potent vasoconstrictor: Improves coronary blood-flow. Dosage = 40 units (2 ml) IV

Note: One dose / no other vasoconstrictor (e.g. epinephrine) for 10 mins after the initial dose of vasopressin. Must be the first vasoconstrictor used or not used at all.

Attempt to defibrillate at 360 joules (or equivalent biphasic) after each drug

AMIODARONE: Class IIB or LIDOCAINE: Class IIB indeterminate (no proven efficacy)

MAGNESUM SULFATE (IIb if hypomagnesemic)

PROCAINAMIDE (IIb for intermittent/recurrent VF/VT --- May give 100 mg bolus for VF