Pulseless ventricular tachycardia interventions: Difference between revisions
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Immediate defibrillation is the main intervention for pVT. | Immediate defibrillation is the main intervention for pVT. | ||
==Defibrillation<ref name="urlWhat are the treatment options for pulseless ventricular tachycardia (VT)?">{{cite web |url=https://www.medscape.com/answers/159075-67727/what-are-the-treatment-options-for-pulseless-ventricular-tachycardia-vt |title=What are the treatment options for pulseless ventricular tachycardia (VT)? |format= |work= |accessdate=}}</ref><ref name="pmid32119354">{{cite journal |vauthors=Foglesong A, Mathew D |title= |journal= |volume= |issue= |pages= |date= |pmid=32119354 |doi= |url=}}</ref>== | |||
*As opposed to other unstable [[Ventricular tachycardia]], PVT should be managed with '''immediate [[defibrillation]]'''. A high energy defibrillator (150-200 J on biphasic and 360 J on monophasic) should be used for the initial shock dose, followed by an equal or higher shock dose for successive shocks | |||
*5 CPR cycles each containing 30 chest compressions and 2 breaths should be done after the first shock is delivered. Each subsequent shock should be followed by airway management with Oxygen delivery, and IV access with [[vasopressors]]. | |||
===ACLS Cardiac Arrest Algorithm=== | |||
{{familytree/start |summary=PE diagnosis Algorithm.}} | |||
{{familytree | | | | | | | | | | | | | A01 | | | | | A01='''Adult Cardiac Arrest'''}} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | A02 | | | | | | A02='''Start [[CPR]]'''<br>Give oxygen<br>Attach monitor/defibrillator}} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | A03 | | | | | | A03='''Rhythm shockable?'''}} | |||
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | }} | |||
{{familytree | | | | B01 | | | | | | | | | | | | | | | B02 | B01=Yes| B02=No}} | |||
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }} | |||
{{familytree | | | | C01 | | | | | | | | | | | | | | | C02 | C01='''[[VF]]/[[pVT]]'''| C02='''[[Asystole]]/[[PEA]]'''}} | |||
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }} | |||
{{familytree | | | | D01 | | | | | | | | | | | | | | | |!| | D01=Shock}} | |||
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }} | |||
{{familytree | | | | E01 | | | | | | | | | | | | | | | |!| | E01=<u>'''''Box A:'''''</u><br><br>'''[[CPR]] 2 min'''<br>IV/IO access}} | |||
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }} | |||
{{familytree | | | | F01 |-| F02 |~|7| | | | | | | | | |!| | F01='''Rhythm shockable?'''| F02=No}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }} | |||
{{familytree | | | | G01 | | | | | |:| | | | | | | | | |!| | G01=Yes}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }} | |||
{{familytree | | | | H01 | | | | | |:| | | | | | | | | |!| | H01=Shock}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }} | |||
{{familytree | | | | I01 | | | | | |:| | | | | | | | | I02 | I01=<u>'''''Box B:'''''</u><br><br>'''[[CPR]] 2 min'''<br>[[Epinephrine]] every 3-5 min<br>Consider advanced airway<br>and [[capnography]]| I02=<u>'''''Box C:'''''</u><br><br>'''[[CPR]] 2 min'''<br> IV/IO access<br> [[Epinephrine]] every 3-5 min<br>Consider advanced airway<br>and [[capnography]]}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }} | |||
{{familytree | | | | J01 |-| J02 |~|C| | | | | | | | | J03 |-| J04 | J01='''Rhythm shockable?'''| J02=No| J03='''Rhythm shockable?'''| J04=Yes}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | K01 | | | | | |:| | | | | | | | | K02 | | |:| | K01=Yes| K02=No}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | L01 | | | | | |:| | | | | | | | | |!| | | |:| | L01=Shock}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | M01 | | | | | |:| | | | | | | | | M02 | | |:| | M01='''[[CPR]] 2 min'''<br>[[Amiodarone]] or [[Lidocaine]]<br>Treat reversible causes| M02=<u>'''''Box D:'''''</u><br><br>'''[[CPR]] 2 min'''<br>Treat reversible causes}} | |||
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | N00 | | | | | |D|~|~|~|~| N01 |-| N02 | | |:| | N00= Go back to box A| N01=No| N02='''Rhythm shockable?'''}} | |||
{{familytree | | | | | | | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | | | | | | | | |:| | | | | | | | | O01 | | |:| | O01=Yes}} | |||
{{familytree | | | | | | | | | | | |:| | | | | | | | | |!| | | |:| | }} | |||
{{familytree | | | | | | | | | | | |:| | | | | | | | | P01 |~|~|J| | P01=Shock <br> Then, go to box A or box B}} | |||
{{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}} | |||
{{familytree/end}} | |||
'''Adapted from Adult Cardiac Arrest Algorithm - 2018 Update'''<ref name="urlwww.ahajournals.org">{{cite web |url=https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000613 |title=www.ahajournals.org |format= |work= |accessdate=}}</ref> | |||
==References== | ==References== |
Latest revision as of 00:38, 10 July 2020
Pulseless ventricular tachycardia Microchapters |
Differentiating Pulseless ventricular tachycardia from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Pulseless ventricular tachycardia interventions On the Web |
American Roentgen Ray Society Images of Pulseless ventricular tachycardia interventions |
Risk calculators and risk factors for Pulseless ventricular tachycardia interventions |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]
Overview
Immediate defibrillation is the main intervention for pVT.
Defibrillation[1][2]
- As opposed to other unstable Ventricular tachycardia, PVT should be managed with immediate defibrillation. A high energy defibrillator (150-200 J on biphasic and 360 J on monophasic) should be used for the initial shock dose, followed by an equal or higher shock dose for successive shocks
- 5 CPR cycles each containing 30 chest compressions and 2 breaths should be done after the first shock is delivered. Each subsequent shock should be followed by airway management with Oxygen delivery, and IV access with vasopressors.
ACLS Cardiac Arrest Algorithm
Adult Cardiac Arrest | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Start CPR Give oxygen Attach monitor/defibrillator | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
VF/pVT | Asystole/PEA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Box A: CPR 2 min IV/IO access | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Box B: CPR 2 min Epinephrine every 3-5 min Consider advanced airway and capnography | Box C: CPR 2 min IV/IO access Epinephrine every 3-5 min Consider advanced airway and capnography | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | No | Rhythm shockable? | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
CPR 2 min Amiodarone or Lidocaine Treat reversible causes | Box D: CPR 2 min Treat reversible causes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Go back to box A | No | Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock Then, go to box A or box B | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If no signs of return of spontaneous circulation: Go to box C or box D If return of spontaneous circulation: Start post cardiac arrest care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from Adult Cardiac Arrest Algorithm - 2018 Update[3]
References
- ↑ "What are the treatment options for pulseless ventricular tachycardia (VT)?".
- ↑ Foglesong A, Mathew D. PMID 32119354 Check
|pmid=
value (help). Missing or empty|title=
(help) - ↑ "www.ahajournals.org".