Ventricular Fibrillation (VF/V-Fib)

Ventricular Fibrillation (VF/V-Fib)

David Ray Velez, MD

Ventricular Myocardium Depolarize Erratically in an Uncoordinated Manner

  • Non-Perfusing Rhythm and Fatal if Not Corrected

EKG Pattern

  • Sudden Chaotic Irregular Deflections
  • No Identifiable P Waves, QRS Complexes or T Waves
  • Rate 150-500 bpm

Ventricular Fibrillation (VF/V-Fib)

Causes

  • Myocardial Ischemia
  • Cardiomyopathy
  • Prolonged QT Syndrome
  • Cardiac Tamponade
  • Blunt Cardiac Injury
  • Pulmonary Embolism
  • Pneumothorax
  • Pulmonary Hypertension
  • Electrolyte Derangements
  • Aspiration
  • Sepsis
  • Seizure
  • Hypothermia

Treatment

  • Follow ACLS Guidelines: *See Cardiac Arrest
  • Start CPR Immediately and Give Oxygen
  • Treat Any Reversible Causes
  • Check Rhythm Every 2 Minutes
    • Ventricular Fibrillation is a Shockable Rhythm
    • Defibrillate
      • Initial Dose: Biphasic 120-200 J
      • Higher Subsequent Doses May Be Considered
  • Drug Therapy:
    • Epinephrine
      • The First Agent Given
      • Dose: 1 mg IV/IO
      • Give Initially and Repeat Every 3-5 Minutes
    • Amiodarone
      • Dose: 300 mg (First Dose) and 150 mg (Second Dose)
      • Generally Given After Epinephrine if Still in Arrest After Next Rhythm Check
    • *See Antiarrhythmic Pharmacology
  • Adjuncts:
    • Calcium Chloride
      • Dose: 1 g IV
      • Vasopressor and Inotropic Effects
      • Not Routinely Given but May Be Considered
    • Sodium Bicarbonate
      • Dose: 50-100 mEq IV (1-2 Amps/Ampules)
      • Can Mitigate the Effects of Acidosis and Hyperkalemia
      • Not Routinely Given but May Be Considered if Concerned for Significant Acidosis or Hyperkalemia

Cardiac Arrest Management Algorithm:

Immediate CPR and Oxygen

Check Rhythm Every 2 Minutes:

  • VF/pVT:
    • Defibrillate
    • Alternate Epinephrine and Amiodarone After Each Check
  • PEA/Asystole:
    • Epinephrine After Every Other Check

Adjuncts:

  • Calcium Chloride
  • Sodium Bicarbonate