When ventricular fibrillation occurs in a CCU, the first person reaching the client should:
A. Administer oxygen.
B. Defibrillate the client.
C. Initiate CPR.
D. Administer sodium bicarbonate intravenously.
Correct Answer: B. Defibrillate the client
Ventricular fibrillation is a death-producing dysrhythmia and, once identified, must be terminated immediately by precordial shock (defibrillation). This is usually a standing physician’s order in a CCU. Pulseless VT and VF are both shockable rhythms, and once the staff identifies the rhythm as VF, patients should be shocked immediately with 120 to 200 joules on a biphasic defibrillator or 360 joules using a monophasic.
Option A: Professionals should undertake cause-specific measures such as securing the airway, correcting electrolytes, administering fluids, decompressing pneumothorax, draining tamponade while resuscitating the patient. Once the patient attains return of spontaneous circulation (ROSC), physicians should begin a definitive evaluation for coronary artery disease.
Option C: Due to the high mortality rate and extreme acuity of the condition, VF patients warrant immediate attention. Healthcare professionals should immediately initiate guideline-directed management as per Advanced Cardiac Life Support (ACLS) protocol. There is a lower likelihood of survival if the healthcare professional deviates from the ACLS guidelines. All patients with cardiac arrest should have an initial assessment while receiving quality CPR.
Option D: Administer epinephrine and amiodarone as per ACLS protocol in patients sustaining VF rhythm regardless of receiving 3 shocks. Amiodarone significantly improves survival to hospital admission without affecting survival to hospital discharge.
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