ventricular fibrillation

Question 1

investigations

Answer 1

1st investigations

• ECG
• electrolytes
• troponin
• CK-MB

Question 2

management

Answer 2

Ventricular fibrillation (VF) Pulseless or unstable VT: 
Use asynchronized DC shock 

Stable VT:
• Give high-flow oxygen by face mask.
• Obtain IV access. Send U&E, cardiac enzymes, Ca2+, Mg2+. Correct low K+or Mg2+.
• Obtain 12-lead ECG.
• ABG (if evidence of pulmonary oedema, reduced conscious level, sepsis).
• Amiodarone IVI as on page 124. Phlebitis may result if peripheral line used, especially if concentration >2mg/mL. Rarely, lidocaine 50mg over 2min instead, followed
by infusion; see BNF.
• If polymorphic (torsade de pointes) magnesium sulphate 2g over 5min.
• If this fails, or if cardiac arrest, use DC shock (p806 and inside back cover).
• After correction of VT, establish the cause from history/investigations.
• Maintenance antiarrhythmic therapy may be required, eg amiodarone.
• Prevention of recurrent VT: implantation of automatic defibrillators (ICD) may help.
In refractory cases radiofrequency ventricular tachycardia ablation may be tried.