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CODE MANAGEMENTVentricular Tachycardia & Ventricular Fibrillation
VT / VF
OBJECTIVES:
• Define VT
• Define VF
• ACLS Cardiac Arrest Algorithm for VT / VF
• ACLS Post Cardiac Arrest Care Algorithm
VT / VF
What is ventricular tachycardia?
• Myocardial contraction arising from a ventricular impulse, too rapid to sustain adequate cardiac output.
VT / VF
What is ventricular fibrillation?
• Rapid uncoordinated contraction of individual myocardial cells leading to inability of the myocardium to contract as a whole.
VT / VFWhat causes VT and VF?
• Myocardial Ischemia • Acute Coronary Syndrome (STEMI/NSTEMI/Type II MI)• Electrolyte Disturbances • Toxicology (CCB/Beta-Blockers)• Structural Heart Disease (valve problems)• Cardiomyopathy (Dilated/Restrictive/Hypertropic)• Infection • CHF• Long QT Syndrome• Pulmonary Embolism• Unknown cause
In many case, the cause of the VT or VT may not be know.
Goal of Care: Immediate CPR + Shock = ↑ Odds of ROSC
VT / VF
What do I need to know?
• High quality CPR (30:2) is essential.• VT and VF are shockable rhythms.• Epinephrine 1mg IV q3-5minutes• Amiodarone 300mg IV • Early CPR and shock improves outcomes.• If ROSC → Post Cardiac Arrest Algorithm• If PEA PEA Cardiac Arrest Algorithm
VT / VF
VT / VFWhat happens if we achieve ROSC?
• Prepare to manage Post Cardiac Arrest Syndrome.
• Occurs with the return of spontaneous circulation.
• Ischemia and reperfusion injury can cause vasodilation (low BP).
• Cardiac dysfunction and pump failure (dilated cardiomyopathy).
• Post cardiac arrest brain injury.
• Severity depended on duration of code and patient history.
VT / VFHow do I manage Post Cardiac
Arrest Syndrome?
• Airway management• Sedation• Levophed Infusion• Antiarrhythmic Agents• Labs / CXR / CT• Transfer to ICU, OR, or Cath
Lab.• Consider cooling the patient
VT / VFReferences:
• ACLS 2015 PEA and Post Cardiac Arrest guidelines
• CC 90-015 – D http://policy.nshealth.ca/Site_Published/DHA9/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=53045
• Pulseless Electrical Activity, Circulations, 2013;128;2532-2541 http://circ.ahajournals.org/content/128/23/2532.short
• A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity, Medical Principals & Practice, 2014;23:1-6 https://www.karger.com/Article/FullText/354195
• Post Cardiac Arrest Syndrome A Review of Therapeutic Strategies, Circulation, 2011;123:1428-1435. http://circ.ahajournals.org/content/123/13/1428
