(b) Unstable casualty. Follow this procedure for the casualty who has
chest pain, a systolic blood pressure less than 90 mm Hg, and a pulse.
1 Perform nonsynchronized cardioversion in the following
a Give 50 joules.
b If there is no change, give 100 joules.
If there is still no change, give 200 joules.
d If there is still no change, give 360 joules.
2 Administer lidocaine 1 mg/kg intra-venously bolus. This may be
followed by 0.5 mg/kg intravenously every 8 minutes up to a total of 3 mg/kg
Figure 2-31. Ventricular tachycardia.
d. Ventricular Fibrillation).
(1) Analysis. The rhythm, rate, P waves, P-R interval, and QRS complex
are totally chaotic with no discernible waves or complete complexes in this abnormality.
The ventricles fire in a totally disorganized fashion, and, instead of beating, the
ventricular muscle quivers. Consequently, there is no cardiac output, and the
ventricular fibrillation is the same as death. The casualty is clinically dead. Normal
heart rhythm must be restored within a few minutes or biologic death follows. When you
see a rhythm on the monitor that resembles ventricular fibrillation, check quickly to be
sure this pattern is not caused by muscle tremor, loose leads, or patient movement