This document defines ventricular tachycardia and ventricular fibrillation, and outlines the ACLS algorithms for cardiac arrest caused by VT/VF. VT is defined as too rapid myocardial contraction preventing adequate cardiac output, while VF is rapid, uncoordinated myocardial cell contraction preventing coordinated contraction. Causes include ischemia, structural heart issues, electrolyte disturbances, and others. Immediate CPR and defibrillation improve odds of return of spontaneous circulation (ROSC). If ROSC is achieved, post-cardiac arrest care is needed to manage ischemia/reperfusion injury risks like low blood pressure and cardiac dysfunction.

1. CODE MANAGEMENT
Ventricular Tachycardia & Ventricular Fibrillation

2. VT / VF
OBJECTIVES:
• Define VT
• Define VF
• ACLS Cardiac Arrest Algorithm
for VT / VF
• ACLS Post Cardiac Arrest Care
Algorithm

3. VT / VF
What is ventricular
tachycardia?
• Myocardial contraction
arising from a ventricular
impulse, too rapid to
sustain adequate cardiac
output.

4. VT / VF
What is ventricular fibrillation?
• Rapid uncoordinated contraction of individual
myocardial cells leading to inability of the
myocardium to contract as a whole.

5. VT / VF
What causes VT and VF?
• Myocardial Ischemia
• Acute Coronary Syndrome (STEMI/NSTEMI/Type II MI)
• Electrolyte Disturbances
• Toxicology (CCB/Beta-Blockers)
• Structural Heart Disease (valve problems)
• Cardiomyopathy (Dilated/Restrictive/Hypertropic)
• Infection
• CHF
• Long QT Syndrome
• Pulmonary Embolism
• Unknown cause
In many case, the cause of the VT or VT may not be know.
Goal of Care: Immediate CPR + Shock = ↑ Odds of ROSC

6. VT / VF
What do I need to know?
• High quality CPR (30:2) is essential.
• VT and VF are shockable rhythms.
• Epinephrine 1mg IV q3-5minutes
• Amiodarone 300mg IV
• Early CPR and shock improves
outcomes.
• If ROSC → Post Cardiac Arrest
Algorithm
• If PEA  PEA Cardiac Arrest Algorithm

7. VT / VF

8. VT / VF
What happens if we achieve ROSC?
• Prepare to manage Post Cardiac Arrest
Syndrome.
• Occurs with the return of spontaneous
circulation.
• Ischemia and reperfusion injury can cause
vasodilation (low BP).
• Cardiac dysfunction and pump failure (dilated
cardiomyopathy).
• Post cardiac arrest brain injury.
• Severity depended on duration of code and
patient history.

9. VT / VF
How do I manage Post
Cardiac Arrest Syndrome?
• Airway management
• Sedation
• Levophed Infusion
• Antiarrhythmic Agents
• Labs / CXR / CT
• Transfer to ICU, OR, or
Cath Lab.
• Consider cooling the
patient

10. VT / VF
References:
• ACLS 2015 PEA and Post Cardiac Arrest guidelines
• CC 90-015 – D
http://policy.nshealth.ca/Site_Published/DHA9/document_render.aspx?document
Render.IdType=6&documentRender.GenericField=&documentRender.Id=53045
• Pulseless Electrical Activity, Circulations, 2013;128;2532-2541
http://circ.ahajournals.org/content/128/23/2532.short
• A Simplified and Structured Teaching Tool for the Evaluation and Management of
Pulseless Electrical Activity, Medical Principals & Practice, 2014;23:1-6
https://www.karger.com/Article/FullText/354195
• Post Cardiac Arrest Syndrome A Review of Therapeutic Strategies, Circulation,
2011;123:1428-1435. http://circ.ahajournals.org/content/123/13/1428