What is the first treatment for ventricular fibrillation?
Epinephrine is the first drug given and may be repeated every 3 to 5 minutes. If epinephrine is not effective, the next medication in the algorithm is amiodarone 300 mg. Defibrillation and medication are given in an alternating fashion between cycles of 2 minutes of high-quality CPR.
Which drug is used for management of ventricular fibrillation?
In acute ventricular fibrillation (VF), drugs (eg, vasopressin, epinephrine, amiodarone) are used after three defibrillation attempts are performed to restore normal rhythm.
What is the first line treatment for ventricular tachycardia?
Anti-arrhythmic medications are the first-line therapy in emergency departments and CCUs, as discussed earlier. Amiodarone is most commonly used, along with lidocaine, and in some cases procainamide.
Why is amiodarone used in ventricular fibrillation?
Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients.
Why is epinephrine used in ventricular fibrillation?
Clinical studies suggest that epinephrine facilitates ventricular fibrillation (VF) although mechanisms remain unclear. We tested the hypothesis that epinephrine increases the probability of inducing VF and stabilizes VF in association with shortening of fibrillation action potential duration.
What is the management of ventricular tachycardia?
If you have ventricular tachycardia, you may be given medications called anti-arrhythmics by mouth or IV to slow the fast heart rate. Other heart medications, such as calcium channel blockers and beta blockers, may be prescribed with anti-arrhythmic drugs.
Which of following drug is used specially in ventricular arrhythmia?
Amiodarone (Cordarone, Pacerone, Nexterone) Amiodarone is the drug of choice for the treatment of hemodynamically unstable VT that is refractory to other antiarrhythmic agents.
Is amiodarone used for ventricular tachycardia?
Amiodarone is used to manage virtually all forms of supraventricular and ventricular tachycardia and has therefore become one of the most frequently used antiarrhythmic drugs in clinical practice.
What is the most successful treatment for ventricular fibrillation?
External electrical defibrillation remains the most successful treatment for ventricular fibrillation (VF). A shock is delivered to the heart to uniformly and simultaneously depolarize a critical mass of the excitable myocardium. The objectives are to interfere with all reentrant arrhythmia and to allow any intrinsic cardiac pacemakers to assume the role of primary pacemaker.
What is the surgical treatment for ventricular arrhythmias?
Surgical treatment of ventricular arrhythmias in patients with nonischemic heart disease includes excision of VT foci after endocardial mapping and excision of LV aneurysms. This is practiced very infrequently due to significant morbidity and limited efficacy.
What is VF treatment?
Acute ventricular fibrillation (VF) is treated according to Advanced Cardiac Life Support (ACLS) protocols. [ 81, 82] ) Interest in improving rates of public cardiopulmonary resuscitation (CPR) training—with a special emphasis on the use of early defibrillation with automated external defibrillators (AEDs) by public service personnel (eg, police, fire, airline)—is widespread. [ 2] These measures can help to achieve the greatest public health benefits in the fight against sudden death.
How much does defibrillation success rate decrease?
Defibrillation success rates decrease about 5%-10% for each minute after the onset of VF. In strictly monitored settings where defibrillation was performed most promptly, success rates of 85% have been reported.
How long does it take for a defibrillator to recover?
Recovery of cardiac output may take minutes to hours.
What are the factors that determine the success of a defibrillator?
Successful defibrillation largely depends on two key factors: the duration of the VF and the metabolic condition of the myocardium. The VF waveform usually begins with a relatively high amplitude and frequency; it then degenerates to a smaller and smaller amplitude until, after approximately 15 minutes, asystole is reached, possibly because of depletion of the heart's energy reserves. Unfortunately, VF waveform measures do not appear to be useful for differentiating ischemic from nonischemic cardiac arrest etiology. [ 88]
What happens when you defibrillate a patient?
If customary voltage is used to defibrillate a patient, the proportion of myocardial fraction (CK-MB) should remain within reference ranges unless an infarction has caused myocardial injury.
What is VA in cardiac?
Arrhythmias originating from the ventricular myocardium or His-Purkinje system are grouped under ventricular arrhythmia (VA). This includes a subset of arrhythmias such as ventricular tachycardia (VT), ventricular fibrillation (VF), premature ventricular contractions (PVC), and ventricular flutter. Wide complex tachycardia (WCT) is used to define all tachyarrhythmia with QRS complex duration greater than 0.12 seconds. VF is a WCT caused by irregular electrical activity and characterized by a ventricular rate of usually greater than 300 with discrete QRS complexes on the electrocardiogram (ECG). This activity reviews the causes, pathophysiology, and presentation of VF and highlights the role of the interprofessional team in its management.
How to prevent VF?
Primary prevention has been a significant factor in reducing VF-related SCDs. Most VF transition from VT and other VA and hence identifying such arrhythmias at an early stage can help prevent VF. In patients with symptoms suspected to be related to VA, detection using ambulatory electrocardiography and implanted cardiac monitors is recommended. [7]. Healthcare professionals should offer family members of patients with inherited arrhythmia syndromes genetic testing and counseling for risk stratification.
What are the symptoms of VF?
Patients may demonstrate signs of acute MI such as chest pain, shortness of breath, nausea, and vomiting before the event. Patients with a known history of coronary artery disease or congestive heart failure may show a worsening of chronic symptoms such as angina, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pedal edema. At the time of presentation, patients are unconscious, unresponsive, and have no palpable pulse. Without prompt action, this leads to death within the next few minutes. Patients with ICD for primary or secondary prevention can experience shock from ICD firing at the time of experiencing VF.
What causes VF in MI?
VF is often linked to underlying structural heart disease. Three percent to 12% of cases of myocardial infarction (MI) develop VF during the acute phase.[2] MI patients with complete coronary occlusion on an angiogram, anterior wall infarction, atrial fibrillation, and pre-infarction angina are more prone to develop VF.[3] Many common conditions associated with VF include electrolyte abnormalities (hypokalemia/hyperkalemia, hypomagnesemia), acidosis, hypothermia, hypoxia, cardiomyopathies, family history of sudden cardiac death, congenital QT abnormalities, Brugada syndrome, and alcohol use. Patients with a history of VA especially sustained monomorphic or polymorphic VT may transition to VF in susceptible patients.[4] Genetic predisposition to VF is now increasingly recognized. The first genome-wide association was reported in the AGNES study identifying susceptibility locus for VF at 21q21. [5]
Can VF be reversed?
VF outside the hospital can be reversed as today there are defibrillators available in many places. But the success of reversal declines at a rate of 5-10% for every minute that is delayed. Even under ideal circumstances, 30-40% of patients survive but many also develop residual neurological deficits because of anoxia. Full recovery is rare.
Is amiodarone an antiarrhythmic?
Amiodarone is the most commonly studied antiarrhythmic for prevention of SCD. The overall effect of amiodarone on survival is controversial. Most studies have failed to show any added benefit when compared to placebo or ICD.[12] Sotalol, on the other hand, is associated with an increased risk of mortality by decreasing the defibrillation threshold. A meta-analysis published in 2007 showed a significant reduction in risk of SCD with statin treatment.[13] Lower SCD incidence has been reported in patients on chronic beta-blocker therapy for heart failure with reduced ejection fraction.
Why is defibrillation important?
Urgent defibrillation is essential for survival in the management of acute strokes.
What is the only treatment for an unstable tachycardic individual?
Medication is the only treatment for an unstable tachycardic individual.
Why should you defibrillate if you have no pulse?
If the AED advises no shock, you should still defibrillate because defibrillation often restarts the heart with no pulse.
What is an organized rhythm without a pulse?
Any organized rhythm without a pulse is defined as pulseless electrical activity (PEA).
When should an individual be cleared before a shock?
An individual should be cleared-Ñ prior to a shock only when convenient.
Can you use an AED in water?
A) Do not use an AED in water.
How much does defibrillation rate decrease after VF?
Defibrillation success rates decrease 5-10% for each minute after onset of VF. The likelihood of defibrillation success can also be predicted based on the smoothness of the VF tracing. In strictly monitored settings where defibrillation was most rapid, 85% success rates have been reported.
What are the factors that affect the success of a defibrillator?
Successful defibrillation largely depends on the following two key factors: duration between onset of VF and defibrillation, and metabolic condition of the myocardium. VF begins with a coarse waveform and decays to a fine tracing and eventual asystole. These electrical changes that occur over minutes are associated with a depletion of the heart's energy reserves. CPR slows the progression of these events, but defibrillation is the primary treatment to interrupt the process and return the heart to a perfusing rhythm.
What is the importance of prehospital care?
Because of the critical importance of early defibrillation, prehospital care is vital for arrests due to ventricular fibrillation (VF) that occur outside the hospital. Interventions that impact survival and outcome of resuscitation include the following: Witnessed or early recognition of an arrest.
What is the AHA approach to CCC?
[ 21] This approach emphasizes minimal interruption of continuous chest compressions (CCC) for victims of witnessed cardiac arrest. More recent data do not suggest a difference in outcome between performance of CPR by EMS providers with chest compressions that are continuous or interrupted by artificial ventilations. [ 22]
How long does CPR take for VF?
Patients with VF for 4-5 minutes or more at the time defibrillation becomes available may benefit from a 1- to 3-minute period of CPR prior to initial defibrillation. The theoretical benefit of this intervention is "to prime the pump" by restoring some oxygen and other critical substrates to the myocardium to allow successful contraction post defibrillation. The clinical benefit of this intervention remains uncertain, but it has now been included as an optional protocol for Emergency Medical Services (EMS) in the AHA ACLS guidelines. [ 18, 29, 30]
What are the shockable rhythms of AEDs?
[ 24, 25] AEDs are programmed to recognize three shockable rhythms: coarse ventricular fibrillation, fine ventricular fibrillation, and rapid ventricular tachycardia.
Why do rescuers remove patches from chest wall?
Prior to any defibrillation, remove all patches and ointments from the chest wall because they create a risk of fire or explosion. The patient must be dry and not in contact with metallic objects. Goal.
Which type of cell depolarizes independently rather than in response to an impulse from the SA node?
A. many different cells in the heart depolarize independently rather than in response to an impulse from the SA node.
What happens when D.cardiac cells fail to repolarize?
D.cardiac cells in the ventricles fail to completely repolarize, resulting in a decrease in ventricular automaticity.
Is Defibrillation indicated in some cases of asystole?
D. Defibrillation is indicated in some cases of asystole.
