Ventricular Fibrillation: The Daily PANCE Blueprint
An 80-year-old male with a history of CAD (s/p PCI), CHF (last echo revealed EF 35-40%), COPD, HTN, andT2DM is admitted to the hospital for an acute exacerbation of his heart failure. You round on him, but during your physical exam he suddenly goes into ventricular fibrillation. What is the next best step?
A. Send to the cath lab immediately
B. Get a 12-lead EKG and trend troponins
C. Apply pads and defibrillate
D. Push epinephrine, give 1000 cc fluid bolus
E. Give 300 mg amiodarone and 50 mg lidocaine
Answer and topic summary
The answer is C. Apply pads and defibrillate
Patients who have ventricular fibrillation (VF) are at high risk for sudden cardiac death. Risk factors for ventricular fibrillation include underlying structural myocardial disease, electrolyte derangements, myocardial ischemia, drugs (e.g., sympathomimetics like dobutamine or albuterol), mechanical stress, catecholamine excess, etc. The first thing indicated for ventricular fibrillation is prompt cardioversion (ideally applied less than 4 minutes after onset of VF; success declines after 4 minutes). For refractory or recurrent VF, intravenous amiodarone or lidocaine is usually advisable after the initial resuscitation. Since VF occurs in up to 10% of all cases of MI, it also would be reasonable to send to the cath lab after the patient stabilizes if clinically you suspect a myocardial infarction (e.g., multiple cardiac risk factors, elevated troponin, chest pain, EKG with new STT changes, etc). You would want to be cautious with giving fluids to this patient with an EF of 35%.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Emergency Medicine PAEA EOR topic list
