Ventricular Fibrillation (Smarty PANCE)

What is ventricular fibrillation?

Ventricular fibrillation is a life-threatening heart rhythm in which multiple foci in ventricles fire, leading to chaotic quivering of the ventricles and no useful contractions

Ventricular fibrillation most commonly develops secondary to what myocardial abnormality?

Ventricular fibrillation most commonly develops secondary to myocardial ischemia. Ischemia increases the excitability of the myocardium and thus predisposes to ventricular fibrillation.

Patients with ventricular fibrillation are always hemodynamically (stable/unstable)?

Patients with ventricular fibrillation are always hemodynamically unstable.

What is the initial management of ventricular fibrillation is cardiopulmonary resuscitation?

The initial management of ventricular fibrillation is cardiopulmonary resuscitation

What is the treatment of ventricular fibrillation?

Treat with unsynchronized cardioversion using the following algorithm:

● Unsynchronized cardioversion => start CPR

● Give 3 sequential shocks (120, 150, 180); assess rhythm

If VF persists --> do CPR and intubate

● Administer two doses amiodarone 2-4 min. Administer 1 mg IV bolus epi every 3-5 minutes (will ↑ myocardial blood flow and ↓ cerebral blood flow and ↓ defib threshold)

An electric shock during a _______ wave can cause ventricular fibrillation?

An electric shock during a T wave can cause ventricular fibrillation

What's the difference between cardioversion and defibrillation?

● Cardioversion: shock is in synchrony with QRS complex

● Defibrillation: shock is NOT in synchrony with QRS complex (goal to convert dysrhythmia to NSR)

What is used for the prevention of recurrent ventricular fibrillation in the predisposed patients?

Implantable cardioverter-defibrillators are the devices used for the prevention of recurrent ventricular fibrillation in the predisposed patients.

Name two illicit drugs that could cause ventricular fibrillation

Two illicit drugs that could cause ventricular fibrillation are cocaine and methamphetamine

What technique can be used for reversing witnessed ventricular fibrillation in the absence of defibrillators?

Precordial thump can be used for reversing witnessed ventricular fibrillation in the absence of defibrillators