VF & Pulseless VT
Ventricular fibrillation and pulseless ventricular tachycardia are the rhythms where early defibrillation saves the most lives. They are the first pathway taught and tested on an ACLS course.
The pathway
High-quality CPR → shock as soon as possible → CPR 2 minutes → rhythm check → shock if still shockable → CPR with adrenaline → shock → CPR with amiodarone or lidocaine → treat reversible causes throughout.
Start high-quality CPR, give oxygen and attach the monitor or defibrillator. When VF or pulseless VT is confirmed, shock as soon as possible. Biphasic energy follows the manufacturer’s recommendation; if unknown, the maximum available is used.
If the rhythm becomes non-shockable, move to the asystole and PEA pathway; if there are signs of return of circulation, move to post-arrest care.
Compressions of 100 to 120 a minute, at least 5 cm deep, with full recoil and minimal pauses; swap compressors every 2 minutes; avoid over-ventilation. With an advanced airway, give one breath every 6 seconds with continuous compressions. Waveform capnography helps: a persistently low end-tidal CO2 suggests CPR needs improving.
Adrenaline and the antiarrhythmics, with doses and timing, are covered in ACLS drugs. Defibrillation itself is covered in electrical therapy.
Search for the H’s and T’s from the start, especially if VF keeps recurring.
This guide summarises what the ACLS course teaches for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s policies.
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High-quality CPR and defibrillation as soon as possible.
After defibrillation attempts, typically after the second shock, then every 3 to 5 minutes.
Amiodarone or lidocaine for VF or pulseless VT that persists after shocks.
CPR resumes immediately for 2 minutes before the next rhythm check.
Yes, both follow the shockable pathway.
Reading an algorithm is not the same as running one. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site ACLS and a two-year AHA ACLS Provider eCard.
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Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.