Cardiac Arrest - Shockable (VF/VT)

🔑 Key Priorities

• Declare emergency: "This is a CRISIS – Shockable Cardiac Arrest (VF/VT)"

• Early defibrillation is crucial

• Maintain high-quality CPR with minimal interruptions

• Identify and treat reversible causes (4 Hs, 4 Ts)

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🧠 Team Actions

Role	Task
Team Leader	Hands-off coordination, timing, decision-making
Airway Manager	Secure airway, 100% O2, EtCO₂ monitoring
Circulation Lead	IV/IO access, drug administration
Compressor	High-quality CPR, rotate every 2 mins
Recorder	Log time, drugs, shocks, rhythm

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⚡ Management Algorithm

Start Immediately:

1. Begin CPR (100–120/min), 100% O₂

2. Apply defibrillator pads

3. Charge defibrillator while continuing CPR

4. Rhythm check → if VF/VT → SHOCK

Post-shock (each cycle = 2 minutes)

• Resume CPR immediately

• Administer drugs per cycle:

  • Cycle 2: Adrenaline 1mg IV

  • Cycle 3: Amiodarone 300mg IV

  • Cycle 5: Amiodarone 150mg IV

• Repeat adrenaline every 2nd cycle

• Shock every CPR cycle if VF/VT persists

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💉 Drug Table (Adult)

Drug	Dose	Indication
Adrenaline	1mg IV every 3–5 min	Vasopressor support during arrest
Amiodarone	300mg IV bolus, then 150mg	Refractory VF/VT
Magnesium Sulphate	1–2g over 3 min	Torsades de Pointes
Calcium Chloride	10mL of 10%	Hyperkalaemia or CCB overdose
Sodium Bicarbonate	1–2mL/kg of 8.4%	Hyperkalaemia, TCA overdose (not routine)
Lignocaine	1mg/kg IV	Alternative to amiodarone

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💉 Drug Table (Paediatric)

Drug	Dose	Notes
Adrenaline	10mcg/kg IV or IO	Every 3–5 mins
Amiodarone	5mg/kg IV	After 3rd shock
Defibrillation	4J/kg	Every cycle if VF/VT
Magnesium	0.1–0.2mmol/kg (0.2–0.4mL/kg of 49%)	For Torsades

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🔁 Reversible Causes: 4 Hs & 4 Ts

• Hypoxia

• Hypovolaemia

• Hypo/Hyperkalaemia

• Hypothermia

• Tension pneumothorax

• Tamponade (cardiac)

• Toxins

• Thrombosis (cardiac or pulmonary)

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🔄 Ideal Crisis Flow

          VF/VT Arrest
               ↓
        High-Quality CPR
               ↓
    → Defibrillate Immediately
    → Secure Airway + 100% O2
    → Rhythm Check Every 2 min
    → Re-administer Drugs
    → Repeat Shock if needed
    → Search for Reversible Causes

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🧊 Post-ROSC Care

• Titrate SpO₂: 94–98%

• Maintain MAP >65 mmHg

• Consider cooling: TTM 32–36°C

• Avoid hyperglycaemia and hyperoxia

• Organise transfer and post-resus debrief