⚡ Adult VF/Pulseless VT (ACLS)
This tool summarizes ACLS management of adult shockable rhythms (VF/pulseless VT): defibrillation energy, epinephrine timing, and antiarrhythmic dosing, per AHA 2020/2025.
Adult VF/Pulseless VT (ACLS)
Current situation
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 1–2 g) → 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.
- Torsades/polymorphic VT with long QT is treated with magnesium sulfate plus correction of K/Mg and removal of QT-prolonging drugs.
References
- Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support. AHA Guidelines for CPR and ECC. Circulation 2020.
- American Heart Association — 2025 ACLS Cardiac Arrest Algorithm.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.