Cardiac Arrest – Shockable Rhythm

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Shockable Rhythm

When should you do (attempted palpation of carotid or femoral arteries) brief Pulse checks?

  • An organised rhythm is detected on the monitor after 2 minutes of CPR, or
  • The patient shows signs of life.

Chest compressions should continue until the defibrillator is charged.The total pause in chest compressions should be brief and no longer than 5 seconds

ShockabEnergy Selection for Shockable Rytham

  • 150-200 J biphasic for the first shock and 150-360 J biphasic for subsequent shocks

Why a pulse check is not recommended following shock delivery?

  • It is rare for a pulse to be immediately palpable, even if a perfusing rhythm is restored
  • Chest compressions will not induce VF
  • Continuity of CPR is further lost

When do you give drugs in Shockable rhythm?

  • Give adrenaline 1 mg IV and amiodarone 300 mg IV intravenously if VT/VF persists after three shocks.

How often do you give adrenaline?

  • Adrenaline 1 mg IV after alternate shocks (i.e. approximately every 3–5 min)

When do you give amiodarone?

  • Give amiodarone 300 mg IV after three defibrillation attempts. Consider a further dose of amiodarone 150 mg IV after a total of five defibrillation attempts.

When do you give lidocaine?

  • Lignocaine may be given as a 100 mg or 1-1.5 mg/kg bolus intravenously, in the unlikely event of amiodarone not being available. Do not give lignocaine if amiodarone has been given already.

Fine VF or Asystole?

If there is doubt about whether the rhythm is asystole or very fine VF, revert to the non-shockable arm of the algorithm, since:

  • True fine VF is unlikely to be shocked successfully
  • Repeated shock of fine VF or asystole will cause myocardial injury, from both the electricity delivered and the interruptions to CPR
  • Quality CPR may increase the amplitude of fine VF, permitting a successful shock

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