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)

🧠 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

⚡ 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

💉 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

💉 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

🔁 Reversible Causes: 4 Hs & 4 Ts

  • Hypoxia

  • Hypovolaemia

  • Hypo/Hyperkalaemia

  • Hypothermia

  • Tension pneumothorax

  • Tamponade (cardiac)

  • Toxins

  • Thrombosis (cardiac or pulmonary)

🔄 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

🧊 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

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