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Ventricular Tachycardia (VT) – monomorphic:
If still partially conscious, sedate the patient.
Attempt to cardiovert: 1st attempt with 100j, 2nd attempt with 200j, 3rd attempt with 300j, then following attempts with 360j
Ventricular Tachycardia (VT) – polymorphic:
Defibrilate the patient at 360j with a monophasic or 120-200j with a biphasic
Pulseless Ventricular Tachycardia / Ventricular Fibrillation (Refractory):
CABD, ABCD
Using defibrillator:
Verify presence of VF: Defibrillate the patient at 360j using monophasic or at the factory recommended joules for a biphasic.
Drug treatment options:
Epinephrine 1mg IV every 3-5min.
Amiodarone 300mg IVP, repeated once in 3-5 min with following boluses at 150mg.
Magnesium Sulfate: give 1-2gm in 1-2 min
Treat the cause of the arrhythmia.
ACLS Adult Bradycardia with a Pulse
CABD, ABCD
Determine if the patient is stable or unstable.
Stable:
Monitor for changes in the hemodynamic status of the patient.
Unstable:
Give epinephrine 1mg IV every 3-5min until transcutaneous pacing can be initiated.
Initiate transcutaneous pacing until transvenous pacing can be initiated.
If TCP fails or intravenous pacing is delayed consider Epinephrine (2-10 mcg/min IV), Dopamine (5-20 mcg/kg/min), or Isoproterenol (3-20 mcg/mim).
Treat causes (atropine 0.5-1mg IV may be used if vagal mechanism is suspected).
CABD, ABCD
(if lead II is asystolic, confirm rhythm in leads avL and III.)
Drug therapy:
Give epinephrine 1mg IV every 3-5min.
Give atropine 1mg IV every 3-5 min, with a max dose of 3mg.