V-fib after Asystole

[Shell5]

In a code situation a paient is found in asystole. CPR is performed and resucue meds are given. Approximately 5 minutes have elapsed and you see V-fib on the monitor is that then a shockable rhythym?

[jmgrn65, RN]

Yes the only unshockable rhthym is no rhthym such as asystole and PEA but some will agrue to shock aststole because it might be fine VF.

[Shell5]

I don't think there was a pulse, so I take it we were still not to shock even if it showed V-fib on the monitor?

[getoverit, BSN, RN, EMT-P]

If it was v-fib on the monitor, then shock it. one of the purposes in giving epinephrine during a code is to alter the fibrillation threshold, in order to produce a more shockable rhythm. remember coorifice v-fib is typically more responsive to electrical therapy than fine v-fib. the flatter the line...the longer they have been fibrillating.

[MassED, BSN, RN]

In a code situation a paient is found in asystole. CPR is performed and resucue meds are given. Approximately 5 minutes have elapsed and you see V-fib on the monitor is that then a shockable rhythym?

yes, then the algorithm has changed as well.

[ghillbert, MSN, NP]

Yes of course, if you ever see VF, shock it.

[Special31]

Yes, definitely a shockable rhythm

[Nightcrawler, BSN, RN]

I don't think there was a pulse, so I take it we were still not to shock even if it showed V-fib on the monitor?

You won't generally have a pulse with V-tach either, and you still shock that. If you get v-fib back after asystole consider yourself lucky and add electricity ASAP. If you are really lucky you will continue the progress

[joeyzstj, LPN]

I don't think there was a pulse, so I take it we were still not to shock even if it showed V-fib on the monitor?

What would you do if you saw V-tach with no pulse, which commonly happens? V-fib is a shockable rhythm even with no pulse. The patient is dead, and without intervention he or she is going to remain that way.

[ghillbert, MSN, NP]

I don't really understand your question. VF (or rapid VT) most commonly does not have a pulse, because the heart is beating/filbrillating too fast to fill and empty properly and create a pulse.

The purpose of defibrillating is to disrupt that rhythm and restore the electrical (and hence mechanical) firing.

[anurseuk]

Yes definatly. Was this an actual situation you had? What did you do?

[Spatialized]

...in best "Waterboy" accent, "they need some high-quality ee-leck-tri-city!"

It doesn't really matter when you get V-fib, it's always a shockable rhythm, the heart needs a good 200 joule jolt to reset.

Cheers,

Tom