⚡ Adult VF/Pulseless VT (ACLS)
UseUse during resuscitation to anchor the sequence — immediate single defibrillation with high-quality CPR, epin…
SourceAmerican Heart Association — 2025 ACLS Cardiac Arrest Algorithm.
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Defibrillate as a single shock then immediately resume CPR without stacking shocks; give epinephrine after the second shock in shockable rhythms. (original synthesis · not guideline verbatim)
When to use
Use during resuscitation to anchor the sequence — immediate single defibrillation with high-quality CPR, epinephrine every 3–5 minutes, antiarrhythmics for refractory arrest, magnesium for torsades, and structured post-ROSC care.
How it works
Branches: shock (biphasic 120–200 J + CPR + epinephrine 1 mg q3–5min) → refractory (amiodarone 300→150 mg or lidocaine 1–1.5 mg/kg, treat 5H5T) → torsades (magnesium) → ROSC (post-arrest care, TTM, reversible causes).
Key points
- Defibrillate as a single shock then immediately resume CPR without stacking shocks; give epinephrine after the second shock in shockable rhythms. (original synthesis · not guideline verbatim)
- Amiodarone and lidocaine are equivalent options for refractory VF/pVT — choose one, do not combine [unverified].
- Torsades/polymorphic VT with long QT is treated with magnesium sulfate plus correction of K/Mg and removal of QT-prolonging drugs.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current situation | Refractory (still VF/pVT after ≥ 2–3 shocks + epinephrine) |
|---|
→VF/pulseless VTAntiarrhythmic + continued resuscitation
- Amiodarone：300 mg IV/IO bolus (first dose) → if no conversion, another 150 mg
- Lidocaine (alternative)：1–1.5 mg/kg IV/IO first dose, repeat 0.5–0.75 mg/kg if needed (equivalent to amiodarone, choose one, do not combine [unverified])
- Continue：Continue high-quality CPR + epinephrine every 3–5 min + interval defibrillation; consider double-sequential defibrillation, reversible causes (e.g. acute coronary occlusion → emergent PCI, electrolytes, ECPR)
| Current situation | VF/pulseless VT (during resuscitation) |
|---|
→VF/pulseless VTShock + CPR + epinephrine
- Immediate defibrillation：Single shock: biphasic 120–200 J (per manufacturer; if unknown use maximum) first, then equal energy, higher energy may be considered; monophasic 360 J. Resume high-quality CPR immediately after the shock (do not stack shocks)
- CPR：Compressions 100–120/min, depth 5–6 cm [unverified], full recoil, minimize interruptions; recheck rhythm after each 2-minute cycle
- Epinephrine：1 mg IV/IO every 3–5 minutes (give after the 2nd shock in a shockable rhythm)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Adult VF/Pulseless VT (ACLS)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Adult VF/Pulseless VT (ACLS) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Adult VF/Pulseless VT (ACLS) calculated in practice? Can you show a worked example?
- Inputs: Current situation Refractory (still VF/pVT after ≥ 2–3 shocks + epinephrine) → Result: VF/pulseless VT Antiarrhythmic + continued resuscitation（Amiodarone: 300 mg IV/IO bolus (first dose) → if no conversion, another 150 mg, Lidocaine (alternative): 1–1.5 mg/kg IV/IO first dose, repeat 0.5–0.75 mg/kg if needed (equivalent to amiodarone, choose one, do not combine [unverified]), Continue: Continue high-quality CPR + epinephrine every 3–5 min + interval defibrillation; consider double-sequential defibrillation, reversible causes (e.g. acute coronary occlusion → emergent PCI, electrolytes, ECPR)） Inputs: Current situation VF/pulseless VT (during resuscitation) → Result: VF/pulseless VT Shock + CPR + epinephrine（Immediate defibrillation: Single shock: biphasic 120–200 J (per manufacturer; if unknown use maximum) first, then equal energy, higher energy may be considered; monophasic 360 J. Resume high-quality CPR immediately after the shock (do not stack shocks), CPR: Compressions 100–120/min, depth 5–6 cm [unverified], full recoil, minimize interruptions; recheck rhythm after each 2-minute cycle, Epinephrine: 1 mg IV/IO every 3–5 minutes (give after the 2nd shock in a shockable rhythm)）