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ACLS CASES: VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA

RULES FOR VENTRICULAR FIBRILLATION (VF)

Ventricular FIBRILLATION Wave
REGULARITY There is no regularity shape of the QRS complex because all electrical activity is disorganized.
RATE The rate appears rapid but the disorganized electrical activity prevents the heart from pumping.
P WAVE There are no P waves present.
PR Interval There are no PR Interval present.
QRS The ventricle complex varies

RULES FOR VENTRICULAR TACHYCARDIA (VT)
(REGULAR/RAPID WIDE COMPLEX TACHYCARDIA)

Ventricular tachycardia Wave
REGULARITY R-R intervals are usually regular, but not always.
RATE The atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats/minutes.
P WAVE QRS complexes are not preceded by P waves. There are occasionally P waves in the strip, but they are not associated with the ventricular rhythm.
PR Interval PRI is not measured since this is a ventricular rhythm.
QRS Measures more than 0.12 seconds. The QRS will usually be wide and bizarre. It is usually difficult to see a separation between the QRS complex and the T wave.

Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are life-threatening cardiac rhythms that result in ineffective ventricular contractions. VF is a rapid quivering of the ventricular walls that prevents them from pumping. The ventricular motion of VF is not synchronized with atrial contractions. VT is a condition in which the ventricles contract more than 100 times per minute. The emergency condition, pulseless VT, occurs when ventricular contraction is so rapid that there is no time for the heart to refill, resulting in undetectable pulse. In both cases, patients are not receiving adequate blood flow to the tissues. Despite being different pathological phenomena and having different ECG rhythms, the ACLS management of VF and VT are essentially the same. Resuscitation for VF and pulseless VT starts with the BLS Survey.

An AED reads and analyzes the rhythm and determines if a shock is needed. The AED is programmed to only prompt the user to shock VF and VT rhythms. The machine does not know if the patient has a pulse or not. This is the primary reason you should not use an AED in someone with a palpable pulse. ACLS responses to VF and pulseless VT within a hospital will likely be conducted using a cardiac monitor and a manual defibrillator. Thus the ACLS provider must read and analyze the rhythm. Shocks should only be delivered for VF and pulseless VT. Likewise, antiarrhythmic drugs and drugs to support blood pressure may be used.

RULES FOR TORSADES DE POINTES
(IRREGULAR WIDE COMPLEX TACHYCARDIA)

torsades de points wave
REGULARITY There is no regularity
RATE The atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats/minutes.
P WAVE There are no P waves present.
PR Interval There are no PR Interval present.
QRS The ventricle complex varies
VF and pulseless VT are both shockable rhythms. The AED cannot tell if the patient has a pulse or not.