The second lesson of chapter 7 focuses on Ventricular Fibrillation, otherwise known as VF. It also discusses Pulseless Ventricular Tachycardia, often referred to as VT. Appropriate responses and uses of each in a hospital setting are explained.

"Pulseless ventricular tachycardia (VT) and Ventricular fibrillation (VF) are life-threatening cardiac rhythms that result in ineffective ventricular contractions.

The ventricular motion of VF is not synchronized with atrial contractions. VT or VTach is a condition in which the ventricles contract more than 100 times per minute. VF or VFib is a rapid quivering of the ventricular walls that prevents them from pumping.

The emergency condition, pulseless VT, occurs when ventricular contraction is so rapid that there is no time for the heart to refill, resulting in undetectable pulse. In both cases, individuals are not receiving adequate blood flow to the tissues. Despite being different pathological phenomena and having different ECG rhythms, the ACLS management of pulseless VT and VF are essentially the same. Pulseless VT and resuscitation for VF starts with the BLS Survey.

An AED reads and analyzes the rhythm and determines if a shock is needed. The AED is programmed to only prompt the user to defibrillate pulseless VT and VF rhythms. The machine does not know if the individual has a pulse or not. This is the primary reason you should not use an AED in someone with a palpable pulse.

ACLS responses to pulseless VT and VF within a hospital will likely be conducted using a cardiac monitor and a manual defibrillator. Thus, the ACLS provider must read and analyze the rhythm.

Only deliver shocks for pulseless VT and VF. Likewise, antiarrhythmic drugs and drugs to support blood pressure may be used.

The rules for VF include the regularity to have no shape of the QRS complex because all electrical activity is disorganized. The rate appears rapid, but the disorganized electrical activity prevents the heart from pumping. There are no P waves or PR intervals present, and the ventricle complex varies.

The rules for VT include R-R intervals to be usually, but not always, regular. The atrial rate cannot be determined; the ventricular rate is usually between 150 and 250 beats per minute. QRS complexes are not preceded by P waves. There are occasionally P waves in the strip, but they are not associated with the ventricular rhythm. There are no PR intervals present. QRS complex measures more than 0.12 seconds. The QRS will usually be wide and bizarre. It is usually difficult to see a separation between the QRS complex and the T wave.

The rules for Torsades de pointes, which is irregular wide complex tachycardia, include no regularity. The atrial rate cannot be determined. The ventricular rate is usually between 150 and 250 beats per minute. There are no P waves or PR intervals present, and the ventricle complex varies."

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