Protocol 2-968 - V-Fib / Pulseless V-Tach

CMH EMS & MIH Protocols

RN:

Ensure completion of all applicable items above.

If ALS and Cardiac Monitor is available, manual defibrillation is preferred.

Winessed arrest by EMS: Immediate Defibrillation.

Unwitnessed arrest: Perform 2 min of Compressions, then Defibrillation. Immediately start Compressions for 2 min after each shock before rhythm or pulse check.

Every 2 minutes, charge Monitor in anticipation of shock able rhythm. During pause in Compressions, Defibrillate or dump charge.

Adult:	Pediatric:
360 J (OR consider biphasic dose of 200 J).	4 J/kg. Click "calculate" to get dose. Add 2 J/kg each shock (max 10 J/kg). Click "calculate" to get dose.

Consider Amiodarone IV/IO:

Adult:	Pediatric:
300 mg.	5 mg/kg. Click "calculate" to get dose.

Recurrent VF/VT: Repeat Amiodarone:

Adult:	Pediatric:
150 mg.	2.5 mg/kg. Click "calculate" to get dose.

Torsades de Pointes:

Adult:	Pediatric:
Magnesium Sulfate 1-2 g over 2 min. Follow with Magnesium Sulfate 0.5-1 g/hr IV/IO titrated to control Torsades de Pointes. Conscious: Consider Protocol 2-660 - Pain Control. Synchronized Cardioversion 200 J.	Magnesium Sulfate 25-50 mg/kg over 2 min. Click "calculate" to get dose. Conscious: Consider Protocol 2-660 - Pain Control. Synchronized Cardioversion 0.5-1 J/kg. Click "calculate" to get dose.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914017 - Cardiac Arrest-Ventricular Fibrillation/Pulseless Ventricular Tachycardia

Citations:

Protocol 9-010 - References
American Heart Association, 2020
NASEMSO Medical Directors Council, 2017
Perkins, et al., 2018

Change Log:

Date	Link to previous version	Description of change
10/04/13	pdf	Changed witnessed pediatric energy from 2 J/kg to 4 J/kg.
12/12/14	pdf	Added consider Gastric Tube.
12/12/14	pdf	Added consider Gastric Tube.
12/12/14	pdf	Added 20 min of CPR before movement.
12/15/14		Replaced CPR with CCR.
03/31/15		Reverted to CPR per medical director.
04/03/15		Moved Gastric Tube to Protocol 6-110 - Rapid/Delayed Sequence Intubation (RSI).
04/03/15		Moved Gastric Tube to Protocol 6-110 - Rapid/Delayed Sequence Intubation (RSI).
05/31/15		Replaced BLS sections with refer to Protocol 6-025 - Cardiopulmonary Resuscitation (CPR).
11/17/15		Added comment to consider biphasic energy doses.
06/08/16	pdf	Added comment to contact medical control for dual sequential defibrillation after five unsuccessful defibrillations.
08/24/17	pdf	Removed Ativan.
09/20/17		Modified pediatric Versed dosages.
08/03/18	pdf	Per Dr. Kramer, changed Mag Sulfate administration from 15-20 min to 2 min.
08/03/18	pdf	Per Dr. Kramer, changed Mag Sulfate administration from 15-20 min to 2 min.
08/24/18		Added option for Epi drip over five min.
04/06/20	pdf	Added content (without substantive modification) from old Protocol 2-140 - Ventricular Fibrillation (V-FibV-Tach).
04/06/20	pdf	Added content (without substantive modification) from old Protocol 2-120 - Torsades de Pointes.
06/06/21	pdf	Moved to emsprotocols.online
11/30/21		Updated link to Amiodarone.
03/16/23	pdf	Clarified RN and medic roles. Added CP.
03/19/23		Changed link for MagSulfate.
03/19/23		Updated link to Lido.
02/02/24	pdf	Removed Consider Lidocaine section

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Protocol 2-968 - V-Fib / Pulseless V-Tach

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: