Pulseless Arrest V-Fib Teaching (ACLS Algorithms)

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The key steps to treating V-Fib are a rapid assessment to confirm cardiac arrest, starting CPR, applying the defibrillator and delivering the first shock as soon as possible. High quality CPR needs to be performed with as few interruptions as possible by giving cycles of 30 compressions at a depth of 2 to 2.4 inches deep at a rate of 100 to 120 per minute followed by 2 breaths. The compressor needs to be changed every 2 minutes to avoid fatigue. After the initial shock an IV or IO needs to be established in order to give medications. The first medication would be epinephrine, 1 mg 1:10,000 IV or IO push every 3-5 minutes. After the initial dose of epinephrine and a second shock is given, you should consider placing an advanced airway with capnography. Remember that once an advanced airway is in place, CPR compressions become continuous at 100 to 120 compressions a minute, and one breath is given every 6 seconds. The next medication to give is amiodarone, 300 mg via rapid IV or IO push. A 150 mg dose of Amiodarone may repeated one time in 3-5 minutes.
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[@elizabethgrosse3411]

As a nurse, the last thing I'm doing in this scenario is typing my note as I send the aid for an emesis basin

[@dejanmartic360]

I was also confused by this unrealistic scenario :D

[@dandavis1435]

LOL

[@TroyFootballGregKipp]

@@dandavis1435 youll be surprised, this happens often (no disrespect to nurses) but plenty of times I have walked in and NOTHING is being done to patients who are near arrest other than paperwork is ready for EMS

[@rickbar123]

The Aid won’t do it anyway.

[@Unknown_Ooh]

@@rickbar123 its their smoke break time they aren't worried

[@chongjiunkit3901]

@4.49 "it is been about 2 minutes", that completed 2 minutes of CPR, they should pause for pulse check and rhythm check, shock the patient if still in VF (2nd shock), then resume CPR by switching the compressor, then start first dose of 1mg epinephrine IV push. I think the 2nd shock is missing here. Correct me if I am wrong.

[@emilyloeb3811]

I agree

[@baharehkhanali3351]

God bless you. Made it so easy . Thank you

[@bunoroad]

Per AHA. the practitioner checks the carotid pulse prior to calling for help / activating the emergency response system. An uresponsive patient is not necessarily a pulpiness patient. For example, you're not going to call a code on a unresponsive narcotic overdose patient with a bounding carotid pulse.

[@shenilakanji4525]

its incorrect..you need to give 1mg epinephrine IV after the second shock according to AHA 2015.

[@thespaceelefant2441]

According to aha guidelines. Guidelines, local protocol is what will actually dictate what you do

[@heritage.home.crochet]

They're finding that epinephrine is not helping much so as of 2018 the ACLS book says no epi.

[@jahdagod5563]

@@heritage.home.crochet : 👍👍👍

[@liviagrant-d9516]

After two shocks then you will be able to give Epinephrine (1mg)

[@jahdagod5563]

GOOD VIDEO. EXCELLENT PRESENTER. QUESTION EPI...

[@Playbackrm100]

If that 56y/o male who appears in the video is the case, a size 6.0 ETT is definitely too small. This patient will require a size 7.0 ETT at minimum. This will be important for appropriate VTs (Tidal Volumes) once the patient is placed on a vent. Moreover, an End-Tidal CO2 Detector will change colors *(usually from purple to yellow) the second the End-Tidal CO2 Detector is in place between the ETT & the Ambu bag. NOTE: Many times, you can see the exhaled gases in the ETT 'Before' placing the CO2 Detector as well as hear gurgling from secretions. The other VERY IMPORTANT FACTOR is to have a suction catheter kit to clear EXCESS SECRETIONS to prevent additional aspiration and gastric contents.. Henceforth, the clarity of bilateral B.Sounds & chest rise will be evident. I'm just sayin...

[@jithinunnyonline3452]

Good information. നല്ല അവതരണം🙏👍

[@apriljoyannlopez6061]

incorrect on some points as per AHA updated algorithm. 😣

[@chongjiunkit3901]

also, in the same cycle where 1st dose of epinephrine is given, should consider advanced airway, not wait until the next cycle.

[@Norah9O2]

thanx , very clear video

[@pupsiuspupuliukas2394]

Wonder why there isn't one way to do this universally all over the world..some places give epinephrine and amiodarone together...some places do not do this...wonder why there is the discrepancy..

[@Playbackrm100]

Great Point!!!

[@drfranco]

that was splendid.detailed

[@hira2349]

Amazing

[@dandavis1435]

A second line would be great if no central line in place. He started at 360j? No biphasic?

[@drayoubzehri2615]

very useful info

[@fayeperlas1271]

You said 15 breaths per minute, that does mean you continue to give breaths at 15 breaths per minute while chest compression is on going? Is that a new maneuver?

[@jbuccilli1]

if using bls airway adjucts with bvm, acls rate for adults with cpr is 30 comps / with pause for 2 breaths, so roughly at compression rate of 100-120min with 2 second pause for ventilations, you would be delivering apprx 6-8 breaths per min. once advanced airway is in place (ET tube/ LMA/SGA) ventilations become "asynchronous" with one breath given every 6-8 seconds during compressions, which would deliver apprx 8-10 breaths per min.

[@smooth247fyi]

During CPR administer 1 breath every 5-6 seconds for adults. Or base breaths on end tidal capnography results.

[@dandavis1435]

If tubed it doesn't matter. Asynchronous

[@tanner12374]

Give epi after two stacked shocks.

[@jbuccilli1]

what protocol are you getting that order from? as theres no longer stacked shocks, only double sequentional defib if your local protocol allows

[@WajidAli-zc6zn]

B

[@Finkardop]

His uniform white af.

[@Playbackrm100]

LOL!!!!!

[@fayeperlas1271]

B