Woman found pulseless at home

Woman found pulseless at home

Learning Objectives:

1. Describe treatment if you are unsure whether the rhythm is fine ventricular fibrillation or asystole.

2. List the most common causes of ventricular fibrillation.

3. State the antiarrhythmic agent with the best evidence-based support for V Fib and the dose.

4. Discuss the role of sodium bicarbonate in prolonged ventricular fibrillation.

5. Discuss the role of other antiarrhythmics in treating v fib.

V Fib versus Asystole:

1. Fine ventricular fibrillation may look like asystole.

2. If in doubt treat as V Fib since this is the most treatable rhythm.

Most Common Causes of V Fib:

Severe myocardial ischemia.

Hypotension.

Pump failure.

Amiodarone

1. Amiodarone has better evidence-based support than any other antiarrhythmic agent for v fib and pulseless v tach.

2. Administer 300 mg IV push in cardiac arrest.

3. Consider second dose of 150 mg if ventricular fibrillation recurs.

Sodium Bicarbonate:

1. Sodium bicarbonate 1 meq/kg is definitely helpful if the patient has preexisting hyperkalemia.

2. Sodium bicarbonate is probably helpful with tricyclic overdose and to alkalinize urine in drug overdoses.

3. Sodium bicarbonate is possibly helpful if intubated with continued long arrest, and upon return of spontaneous circulation following long arrest.

4. Sodium bicarbonate may be harmful in hypoxic lactic acidosis.

Other Medications in V Fib:

1. Lidocaine administration is acceptable but of indeterminate value. The dose is 1-1.5 mg/kg IV push, repeat in 3-5 min to total loading dose of 3 mg/kg.

2. Magnesium sulfate 1-2 grams IV in Torsades or suspected hypomagnesemic state or refractory VF.

3. Procainamide 30 mg/min in intermittent or recurrent VF is acceptable.

4. Bretylium is no longer recommended due to high incidence of side effects and limited supply.

5. Multiple antiarrhythmics may produce a proarrhythmic effect.