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Dealing With Ventricular Fibrillation In Outpatient Settings

Dealing With Ventricular Fibrillation In Outpatient Settings

Whether in an outpatient facility or upon arriving at a patient’s home following a 911 call, there are various critical situations that medical staff can face. The situation requires a fast response from the first responders, as the sooner appropriate algorithms are implemented, and the right steps are taken, the higher chance of survival for the patient. One such case is with ventricular fibrillation. We take a closer look at the right steps to follow when facing this situation in an outpatient setting.

What Is Ventricular Fibrillation?

Ventricular fibrillation refers to a specific type of arrhythmia that can lead to dangerous complications. It happens when the heart rhythm is irregular. In the event of ventricular fibrillation, the chambers in the lower region of the heart contract too quickly. The contractions are also not normal. When this happens, the heart can’t pump blood throughout the body.

It’s important to understand that this is a medical emergency. If ventricular fibrillation is not attended to without delay, it can lead to sudden cardiac death, in which case the chances of survival fall even more significantly.

Some of the first signs of ventricular fibrillation include chest pain, tachycardia, dizziness, shortness of breath, and nausea. With this said, when this situation gets to the point where it will require emergency medical care, it usually causes the patient to collapse. The other symptoms usually start to show up prior to the collapse. The patient may also lose consciousness during the event.

Ventricular fibrillation can happen due to disruptions in the blood circulatory system, affecting the blood supply to the patient’s heart. It is also possible that the cause is related to the electrical properties of the heart.

The Problem With Ventricular Fibrillation In An Outpatient Setting

It’s important to understand that the equipment available in a hospital can often greatly differ from what outpatient staff have access to. This is where a serious problem arises, especially when looking at scenarios where a patient experiences ventricular fibrillation when they are at home or in a public location.

In these cases, the first responders will only have access to a limited range of equipment, medications, and tools that they can use to address the situation the patient finds themselves in. This is why it is crucial for the medical professionals who work in the field and in outpatient settings to have the necessary knowledge to recognize ventricular fibrillation quickly and to implement the right steps.

How To Deal With Ventricular Fibrillation

The very first step to dealing with ventricular fibrillation is to identify the situation. First responders need to quickly do an investigation on the patient to determine the cause of the event. If the patient has lost consciousness, the medical staff that arrives at the scene can also turn to witnesses in a close perimeter to identify any signs that the patient had prior to collapsing.

If ventricular fibrillation is identified, then the first step is to attempt defibrillation. This particular method is also used as a first response in cases of ventricular tachycardia. Treatment at this point focuses on helping to restore blood flow as quickly as possible, in an attempt to prevent sudden cardiac death. Restoring blood flow without delay can also help to prevent damage to vital organs, as well as the brain.

In cases where an automated external defibrillator is not available straight away, responders on the scene can start to initiate cardiopulmonary resuscitation, also commonly referred to simply as CPR.

With CPR, the idea is to mimic the heart’s natural pumping rhythm and motions. This particular technique can help to ensure blood can continue to flow through the patient’s body. CPR should be continued on the patient until an AED is available. The moment this device becomes available, such as when the EMTs arrive, it should be applied to the patient.

The AED will essentially transfer an electric shock to the patient’s heart, through their chest wall. The primary idea with the use of an AED is to restore the heart’s normal rhythm. Depending on the specific AED that is available, the device may already contain the appropriate programs to identify a condition like ventricular fibrillation. In this case, it will send out shocks to the patient’s heart at the right intervals. 

This type of scenario brings up the importance of certifications and skills required by staff members who work in outpatient settings. Options like ACLS certification can be extremely useful in these cases, as it ensures nurses, EMTs, and other staff members know exactly what to do when the patient shows signs of ventricular fibrillation.

What Happens After Addressing Ventricular Fibrillation

Once the first responders have applied CPR and used an AED device, normal heart rhythm may be restored with these procedures. Afterward, it’s important for the patient to be transported to the hospital. The healthcare professional on duty may need to run a few tests to determine if the patient’s organs and tissues have suffered any damage.

It is important to understand that the patient is still at risk. One study found that in about 7.5% of cases where an AED is used in cases of ventricular fibrillation, over 10 shocks need to be applied before the heart’s normal rhythm is restored. The higher the shock count, the lower the 30-day survival rate was in the findings of the study. The study also notes that 11 other factors seem to have an impact on the 30-day survival rate following the event.

At this point, additional treatment is generally advised. These treatments focus on helping to reduce the risk of the patient experiencing ventricular fibrillation again in the future. A personalized approach is needed, as the healthcare professional will have to identify the causes, complications, and other factors related to the event.

Certain medications can be used to help with the regulation of the patient’s heart rhythm. These medications are known as antiarrhythmics. There are also certain medical devices, such as an ICD (implantable cardioverter-defibrillator), that can be used to help restore a normal heart rhythm if the patient experiences ventricular fibrillation.

Coronary bypass surgery, coronary angioplasty, stent placement, and cardiac ablation are surgical procedures that may be used in cases where certain complications or causes behind ventricular fibrillation are identified.

Conclusion

Ventricular fibrillation can result in sudden cardiac death, especially if not attended to quickly. When faced with this situation in an outpatient setting, it’s important for medical staff to respond without delay, but also to know what steps they need to take. ACLS certifications are extremely useful in these scenarios, which is why it’s important to provide this type of education for EMTs and other outpatient care staff members too.

References

Ventricular fibrillation. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ventricular-fibrillation/symptoms-causes/syc-20364523

J. Holmen, J. Hollenberg, et al. Survival in ventricular fibrillation with emphasis on the number of defibrillations in relation to other factors at resuscitation. Journal of Resuscitation. Published April 2017. https://pubmed.ncbi.nlm.nih.gov/28109996/

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