V-tach is a poorly perfusing rhythm and patients may present with or without a pulse. V-tach typically appears on an ECG monitor as a wide, regular, and very rapid rhythm. Ventricular tachycardia (V-tach) will usually respond well to defibrillation. However, if the patient’s rhythm is asystole, defibrillation will be ineffective. If the patient is in fine VFib, the healthcare provider may be able to terminate the rhythm. When in doubt, though, it is acceptable to deliver a shock. However, the treatments for asystole and VFib are different, therefore, ACLS providers must be able to differentiate between the two. Coarse VFib is more likely to convert after defibrillation than fine VFib.įine VFib can sometimes be mistaken for asystole. On an ECG monitor, VFib will look like a wavy, disorganized line. In VFib cases, the heart quivers ineffectively and as a result, no blood is pumped out. Ventricular fibrillation (or VFib) is a common cause of out-of-hospital cardiac arrest. However, subsequent rhythm checks may reveal a change in the patient’s rhythm to one that is shockable, at which point a shock would be delivered. If a healthcare provider’s rhythm check reveals a non-shockable rhythm – asystole or PEA – the course of action is a continuation of CPR, possible medications, and possible advanced airway capnography. When ACLS providers conduct a rhythm check, if that rhythm check reveals a shockable rhythm – VFib or pulseless V-tach – they will prepare to deliver a shock, while also ensuring the continuation of high-quality CPR while the unit is charging and in between shocks.

A non-shockable rhythm – displayed on the right side of the algorithm.

A shockable rhythm – displayed on the left side of the algorithm.

The algorithm consists of the two pathways for a cardiac arrest:

This algorithm outlines all assessment and management steps that ACLS providers should take for the pulseless patient who does not initially respond to basic life support interventions, including the first shock from an AED (automated external defibrillator). The adult cardiac arrest algorithm is the most important algorithm for adult resuscitation. Shockable Rhythms and the Adult Cardiac Arrest Algorithm

Asystole, seen as a flat line on an ECG monitor.Pulseless ventricular tachycardia, or V-tach.There are two shockable rhythms and two non-shockable rhythms. With that said, defibrillation can reset and restart the heart, which helps buy the healthcare provider time to explore and treat the Hs and Ts – the underlying causes. However, it’s important to know when to use defibrillation to reset the abnormal rhythm and when not to use it.įinding the underlying causes of a cardiac arrest is one of the most important goals for ACLS providers. Along with high-quality CPR, ACLS medications and defibrillation are the only two healthcare interventions that are likely to restart a heart that is in arrest.ĭefibrillation is a powerful tool in the hands of an ACLS provider. One important aspect of ACLS (advanced cardiac life support) is determining the right medication or therapy to use at the appropriate time and this includes deciding when to defibrillate. Shockable rhythms are heart rhythms that are caused by an aberration in the heart’s electrical conduction system.

Pulseless electrical activity shockable