ACLS Ventricular Fibrillation / Pulseless VT
Algorithm
Step 1: Recognition
- Unresponsive, not breathing, no pulse
- Begin CPR immediately
- Attach monitor/defibrillator
Step 2: Shockable Rhythm
- If Ventricular fibrillation (VF) or pulseless VT (pVT) → proceed
Step 3: First Shock
- Defibrillate: Biphasic 120–200 J (as per device) or Monophasic 360 J
- Resume CPR immediately for 2 minutes (do not check pulse yet)
- Ensure high-quality CPR (rate 100–120/min, depth 5–6 cm, full recoil, minimal interruptions)
Step 4: Medications and Shocks
- After 2 min CPR → Rhythm check
- If still VF/pVT → Shock again
- Resume CPR immediately after shock
- During CPR cycles:
• Epinephrine 1 mg IV/IO every 3–5 min (give after 2nd shock, continue every other cycle)
• Amiodarone: 1st dose 300 mg IV/IO bolus, 2nd dose 150 mg IV/IO if refractory
Step 5: Ongoing Management
- Continue CPR + defibrillation + drug administration in cycles
- Consider reversible causes (Hs & Ts):
• Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia
• Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (coronary/pulmonary)
Step 6: Return of Spontaneous Circulation (ROSC)
- Optimize ventilation & oxygenation
- Treat hypotension
- Obtain 12-lead ECG
- Consider emergent coronary reperfusion
- Targeted temperature management (if comatose)
