About-Cardio
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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Understanding Shockable Rhythms in ACLS
Introduction
Advanced Cardiovascular Life Support (ACLS) is a set of clinical protocols used to manage cardiac arrest and life-threatening cardiovascular conditions. One key aspect of ACLS is identifying whether a cardiac arrest rhythm is shockable or non-shockable.
What Are Shockable Rhythms?
Shockable rhythms are those that can be treated with defibrillation. They include:
Ventricular Fibrillation (VF)
- A chaotic, uncoordinated electrical activity in the ventricles.
- The heart cannot pump blood effectively.
- Requires immediate defibrillation.
Pulseless Ventricular Tachycardia (pVT)
- A rapid, abnormal heart rhythm originating in the ventricles.
- The heart beats too fast to allow adequate filling and output.
- Patients in pVT have no pulse and need immediate defibrillation.
ACLS Protocol for Shockable Rhythms
When a patient is in VF or pVT, follow these key ACLS steps:
Start High-Quality CPR
- Ensure effective chest compressions (depth of 5-6 cm, rate of 100-120 per minute).
- Deliver rescue breaths at a ratio of 30:2 (if not intubated).
Defibrillation
- Use a biphasic or monophasic defibrillator.
- First shock: 200J (biphasic) or 360J (monophasic).
- Resume CPR immediately after the shock for 2 minutes before checking for rhythm return.
Administer Medications
- Epinephrine (1 mg IV every 3-5 min) to enhance circulation.
- Amiodarone (300 mg IV bolus, then 150 mg for the second dose) or Lidocaine as an antiarrhythmic if VF/pVT persists after multiple shocks.
Identify and Treat Reversible Causes (H's & T's)
- H’s: Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia.
- T’s: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or coronary).
Summary
Shockable rhythms (VF and pVT) require rapid defibrillation, high-quality CPR, and medications to restore a normal heart rhythm. Early intervention is critical for survival and better neurological outcomes.
Source recommendations
1. American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) Guidelines
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-basic-and-advanced-life-support
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916
- https://shopcpr.heart.org/acls-provider-manual
2. European Resuscitation Council (ERC) Guidelines on Advanced Life Support
- https://pubmed.ncbi.nlm.nih.gov/33773825/
- https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ad.pdf
- https://www.resuscitationjournal.com/article/S0300-9572(21)00063-0/fulltext
- https://cprguidelines.eu/guidelines-2021
- https://www.resuscitationjournal.com/article/s0300-9572(15)00328-7/fulltext
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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Every 3-5 years, half of the scientific approaches to treatment in the field of cardiology are reviewed as a result of specialized scientific discoveries. With us, you don't have to wait these years to learn about the best ways to treat you and your loved ones.