Understanding Advanced Algorithms for the Treatment of Ventricular Fibrillation

VF algorithms to help ACLS providers recall important information.

What is Ventricular Fibrillation (VFib) in ACLS?

VFib (ventricular fibrillation) is the most destructive type of arrhythmia and must be quickly and accurately diagnosed to ensure individuals remain safe. People suffering from VFib need a large-intensity electric current to the heart to get back to normal rhythm. VFib must be treated immediately or else it can prove to be fatal in a matter of minutes. Moreover, if NSR is wrongly assumed as VFib and an unnecessary shock is delivered, the heart can suffer irreparable damage that could even cause death. Accurate and quick detection of VFib is paramount, and thus essential.

Symptoms of VFib

The most recognizable symptoms of VFib are a sudden decrease in physical activity due to the heart not supplying enough blood to both the brain and muscles. This can cause fainting or even complete collapse.

Symptoms include:

  • loss of consciousness
  • chest pain or angina that increases over time
  • swollen feet from retaining excess fluid in the body
  • nausea and vomiting
  • no pulse
  • shortness of breath

RELATED: Ventricular Tachycardia (VT) with Pulse Algorithm for PALS 2022

VF on an ECG
Ventricular Fibrillation visualized on an electrocardiogram (ECG)

Most Common Treatment Options for VFib

Treatment for VFib Includes the Following:

  1. High quality CPR should be performed, involving establishment of an airway, provision of oxygen to keep oxygen saturation above 94%, and monitoring of heart rhythm and blood pressure.
  2. An AED should be equipped with the capability to accurately and quickly distinguish between VFib that is amenable to defibrillation and other nonshockable cardiac rhythms. This is a critical performance requirement in order to optimize the management of sudden cardiac arrest.
  3. Administering epinephrine and/or amiodarone/ or lidocaine when or if needed. Correcting a person’s electrolyte levels may also be critical to the their survival.
  4. Continuing cycles of CPR. AED shocks and medication until return of spontaneous circulation (ROSC).

RELATED: ACLS Algorithm for Supraventricular Tachycardia (SVT)

The Challenges with VFIB Treatment and How Advanced Algorithms Can Help

The main challenge to treating VFib is to act quickly and stabilize the condition immediately. This requires the medical professional to rapidly perform an assessment on the patient to confirm VF and begin treatment immediately.

However, there are a lot of steps that must be taken for proper treatment, and professionals new and experienced will find using an algorithm extremely beneficial as a tool to guide them through.

Advanced Cardiopulmonary Life Support (ACLS) algorithms such as the Adult Cardiac Arrest Algorithm are designed to help healthcare professionals to recall and execute treatment for destructive types of arrhythmia such as VFib.

RELATED: An ACLS Certification Guide for 2023 Medical Candidates

How to Choose the Right Advanced Algorithm for VFib

To ensure the best possible outcome for a patient, it is important to select the right advanced algorithm for VFib. Advanced algorithms can help healthcare professionals quickly diagnose and treat the condition and help reduce the risk of complications.

Resuscitation efforts for arrhythmias such as VFib begin with the BLS Assessment. Once the provider attaches an AED, it will analyze and determine if the rhythm requires a shock.

In a patient with VFib or pVT (pulseless VT), the AED cannot determine if the person has a pulse. Only VF and pVT are shockable rhythms. An ACLS provider in the hospital setting will have to analyze the rhythm on a cardiac monitor and defibrillate manually. In addition, patients with VF or pVT will likely require support medications for arrhythmia/HR control and blood pressure management.

Once you have assessed and determined VFib, cardiac arrest is inevitable if not treated immediately.

Use the following algorithm for the treatment of VFib:

RELATED: Download an ACLS Course Pack and Learn Get All the ACLS Algorithms

Adult Cardiac Arrest Algorithm 

Nonshockable Rhythm

If the distressed person has no shockable rhythm, rescuers should follow this nonshockable rhythm pathway and incorporate the steps of the shockable rhythm path if the victim’s cardiac rhythm becomes shockable. 

Activate emergency response.

  1. Begin CPR, give oxygen, and attach a cardiac monitor or an AED.

Determine if a shockable rhythm is present.

9.  NO (i.e. nonshockable rhythm is present) if Asystole or PEA is present. 

Administer epinephrine ASAP.

10.  Resume CPR for 2 minutes, obtain IV/IO access, administer epinephrine every 3–5 minutes, and consider advanced airway with capnography.

After 2 minutes of CPR, determine if a shockable rhythm is present.

If YES. Go to step 5 or 7 below.

11.  If NO. Resume CPR for 2 additional minutes and treat reversible causes.

After 2 minutes of CPR, determine if a shockable rhythm is present.

12.  If YES. Go to step 5 or 7 below.

  If NO→If there is no shockable rhythm and no signs of ROSC, go to step 10 or 11.    

 Consider the appropriateness of continuing resuscitation effects. If signs of ROSC, 

 begin Post-Cardiac Arrest Care

Shockable Rhythm

Rescuers should follow this pathway if the distressed person has a shockable rhythm. 

Activate emergency response.

  1. Begin CPR, give oxygen, and attach a cardiac monitor or an AED.

After 2 minutes of CPR, determine if a shockable rhythm is present.

  1. YES, it is shockable if VFib or pVT is present. If NO shockable rhythm is present, continue to step 9 (under Nonshockable Rhythm).
  2. Administer shock.
  3. Resume CPR for 2 minutes and obtain IV/IO access.

After 2 minutes of CPR, determine if a shockable rhythm is present.

  1. If YES, administer shock. If NO shockable rhythm and no signs of ROSC, go to step 10 or 11. Consider the appropriateness of continuing resuscitation efforts. If signs of ROSC, go to Post-Cardiac Arrest Care.
  2. Resume CPR for 2 minutes, administer epinephrine every 3–5 minutes and consider advanced airway with capnography.

After 2 minutes of CPR, determine if a shockable rhythm is present.

  1. If YES, administer shock. If NO shockable rhythm and no signs of ROSC, go to step 10 or 11. Consider the appropriateness of continuing resuscitation effects. If signs of ROSC, begin Post-Cardiac Arrest Care.
  2. Resume CPR for 2 minutes, administer amiodarone or lidocaine. Treat reversible causes.

A doctor takes a patient's pulse.

Learn the Algorithms to Treat Arrhythmias Through ACLS Certification

There is no better way to learn how to treat cardiac patients than by taking an accredited ACLS certification course.

With a Medical ProCerts ACLS certification course, you’ll be prepared to treat cardiopulmonary emergencies by learning how to:

  • recognize and provide treatment of a patient during abnormal heart rhythms and cardiac episodes.
  • correctly perform BLS (basic life support).
  • understand ACLS algorithms and protocols.
  • work within effective team dynamics.
  • defibrillate with an AED (automated external defibrillator).
  • know the methods of airway management.
  • understand normal heart anatomy and physiology to quickly identify and treat abnormal deviations.
  • recall drug dosages, access routes and contraindications.
  • provide post-cardiac care.

Sign up for an online, accredited, AHA-compliant ACLS certification course by going to www.medicalprocerts.com Get certified today!

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