Adult VF/Pulseless VT

Question 1

Adult VF/Pulseless VT - Initial actions

Answer 1

CPR
Airway management
Search for and treat possible causes

Question 2

Adult VF/Pulseless VT - Defibrillation dose

Answer 2

360J q 2 min

Question 3

Adult VF/Pulseless VT - Defibrillation indictations

Answer 3

VF/ pulseless VT

Question 4

Adult VF/Pulseless VT - 1st line medication

Answer 4

Epinephrine 1mg IV/IO q 3-5

Question 5

Adult VF/Pulseless VT - 2nd line medication for refractory VF or pulseless VT

Answer 5

Amiodarone 300mg IV q 5
repeat dose 150mg
total max 450mg

Question 6

Adult VF/Pulseless VT - Cardiac arrest if hyperkalemia, hypocalcemia, or hypermagnesemia suspected

Answer 6

Calcium gluconate 3 g SIVP

Question 7

Adult VF/Pulseless VT - Cardiac arrest resulting from ExDS, prolonged resuscitation, pre-existing hyperkalemia (renal failure), TCA or ASA overdose

Answer 7

Sodium Bicarbonate ExDS 2 mEq/kg,

Question 8

Adult VF/Pulseless VT - Excited delerium syndrome cardiac arrest treatment

Answer 8

Sodium Bicarbonate 2 mEq/kg
2L NS
Continuous cooling techniques

Question 9

Adult VF/Pulseless VT - Key features of Excited Delirium Syndrome

Answer 9

History of drug abuse or psychiatric illness
Most often males ~ 35 yo
Hyperthermia
Associated with severe metabolic acidosis
Exceptional strength and endurance without apparent fatigue

Question 10

Adult VF/Pulseless VT - ExDS most common initial rhythm

Answer 10

Asystole

Question 11

Adult VF/Pulseless VT - Epinephrine indication

Answer 11

VF / pulseless VT

Question 12

Adult VF/Pulseless VT - Epinephrine dose

Answer 12

1 mg IV/IO

q 3 – 5 minutes prn

Question 13

Adult VF/Pulseless VT - Amiodarone dose

Answer 13

300 mg IV/IO q 5 min
repeat dose 150 mg IV/IO
Total max 450 mg

Question 14

Adult VF/Pulseless VT - Amiodarone EMS contraindications

Answer 14

Incompatible with Sodium Bicarbonate in same IV line - flush prior or use second line

Question 15

Adult VF/Pulseless VT - Calcium gluconate indications

Answer 15

Cardiac arrest if hyperkalemia, hypocalcemia, or hypermagnesemia, CCB or BB OD suspected

Question 16

Adult VF/Pulseless VT - Calcium gluconate dose

Answer 16

3 g SIVP/IO

Do not repeat dose

Question 17

Adult VF/Pulseless VT - Calcium gluconate EMS contraindications

Answer 17

Hypersensitivity

Hypercalcemia

Question 18

Adult VF/Pulseless VT - Sodium Bicarbonate indications

Answer 18

Cardiac arrest resulting from ExDS
Pre-existing hyperkalemia (renal failure)
TCA or ASA overdose

Question 19

Adult VF/Pulseless VT - Sodium Bicarbonate dose

Answer 19

2 mEq/kg

Question 20

Adult VF/Pulseless VT - Sodium Bicarbonate precautions

Answer 20

Consider early in cardiac arrest secondary to TCA or ExDS

Incompatible with Amiodarone - use second line or flush line completely

Question 21

Adult VF/Pulseless VT - Magnesium Sulphate indications

Answer 21

Cardiac arrest with polymorphic VT / Torsades de pointes

Question 22

Adult VF/Pulseless VT - Magnesium Sulphate dose

Answer 22

2 g IV/IO

Do not repeat dose

Question 23

Adult VF/Pulseless VT - Magnesium Sulphate EMS contraindications

Answer 23

Any degree of heart block

Renal failure

Question 24

Adult VF/Pulseless VT - polymorphic ventricular tachycardia or Torsades de pointes

Answer 24

Magnesium Sulphate 2 g IV/IO

Question 25

Adult VF/Pulseless VT - Amiodarone IVP Administration

Answer 25

Draw up from vial with ported vial access needle

Question 26

Adult VF/Pulseless VT - Early Transport Criteria?

Answer 26

LVAD
High suspicion of PE
Persistent VT
Traumatic Cardiac Arrest
Hypothermic cardiac arrest

Question 27

Adult VF/Pulseless VT - Early Transport Criteria met?

Answer 27

Mandatory OLMC to consider transport