BPLS SHOCKABLE RHYTHM X DC2RCDC2RCDC2RC X AD AFTR3RD THEN ALT CY X AM AFTER 3RD AND 5TH SHOCK X

Shockable (VF/pVT)

This is less common in children but may occur as a secondary event and is likely when there has been a witnessed and sudden collapse. It is seen more often in the intensive care unit and cardiac ward.

• Continue CPR until a defibrillator is available – as 5A above
• Defibrillate the heart:D
  • Charge the defibrillator while another rescuer continues chest compressions.
  • Once the defibrillator is charged, pause the chest compressions, quickly ensure that all rescuers are clear of the patient and then deliver the shock. This should be planned before stopping compressions.
  • Give 1 shock of 4 J kg-1 if using a manual defibrillator.
  • If using an AED for a child of less than 8 years, deliver a paediatric-attenuated adult shock energy.
  • If using an AED for a child over 8 years, use the adult shock energy.
• Resume CPR:DC2
  • Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compression.
  • Consider and correct reversible causes (4Hs and 4Ts).
• Continue CPR for 2 min, then pause briefly to check the monitor:DC2RC
  • If still VF/pVT, give a second shock (with same energy level and strategy for delivery as the first shock).DC2RCD
• Resume CPR:
  • Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compression.DC2RCDC2
• Continue CPR for 2 min, then pause briefly to check the monitor: DC2RCDC2RC
• If still VF/pVT, give a third shock (with same energy level and strategy for delivery as the previous shock).DC2RCDC2RCD
• Resume CPR:
  • Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compression.DC2RCDC2RCDC2
  • Give adrenaline 10 mcg kg-1 and amiodarone 5 mg kg-1 after the third shock, once chest compressions have resumed. AD AFTER 3RD SHOCK ALT CYCLE
  • Repeat adrenaline every alternate cycle (i.e. every 3–5 min) until ROSC.
  • Repeat amiodarone 5 mg kg-1 one further time, after the fifth shock if still in a shockable rhythm.AM AFTER 3RD AND 5TH SHOCK 
• Continue giving shocks every 2 min, continuing compressions during charging of the defibrillator and minimising the breaks in chest compression as much as possible.
  • After each 2 min of uninterrupted CPR, pause briefly to assess the rhythm: If still VF/pVT:    DC2RCDC2RCDC2RC
    
    • Continue CPR with the shockable (VF/pVT) sequence.
  • If asystole:
    
    • Continue CPR and switch to the non-shockable (asystole or PEA) sequence as above.
  • If organised electrical activity is seen, check for signs of life and a pulse:
    
    • If there is ROSC, continue post-resuscitation care.
    • If there is no pulse (or a pulse rate of <60 min-1), and there are no other signs of life, continue CPR and continue as for the non-shockable sequence above.

If defibrillation was successful but VF/pVT recurs, resume the CPR sequence and defibrillate. Give an amiodarone bolus (unless two doses have already been given) and start a continuous infusion of the drug.