VF & Pulseless VT
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步驟 1:
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Basic CPR/ABCD。
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Defibrillation x 3 (300J,300-360J,360J OR equivalent biphasic shocks)。
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Biphasic defibrillations may be superior
to standard monophasic defibrillations。
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步驟 2:
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步驟 3:
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Vasopressin 40 U iv x 1 only (preferred
first agent, Class 2b)。
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Epinephrine1mg q3-5min (Class Indeterminant)。
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步驟 4:
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Defibrillate at 360J or biphasic shock。
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步驟 5:Antiarrhythmics:
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First tier:
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Amiodarone 300 mg iv push, can consider
repeat 150 mg iv x 1 (Class 2b)。
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Second tier:
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Lidocaine 1.0-1.5mg/kg (e.g. 70-100mg) ivp q3-5 min up to 3 mg/kg (e.g.
210mg) (Class Inderterminate)。
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Magnesium 1-2 mg iv if polymorphic VT or hypomagnesiumic (Class 2b)。
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Procainamide 30 mg/min up to 17mg/kg "acceptable but not recommended" in
refractoryVF (but still class 2b)。
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Bicarbonate: prolonged arrest (Class 2b), high K (Class 1), bicarbonate
responsive acidosis (2a), tricyclic OD (2a), to alkinalize urine for aspirin
OD (2a); not for hypercarbia。
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Note: bretylium remains acceptable but no longer recommended in ACLS。
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步驟 6:
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Defibrillate 360J or biphasic shock。
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步驟 7:
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流程圖。