Ventricular Fibrillation (VF)/
Pulseless Ventricular Tachycardia (PVT) 

The following acronym directs AHA accepted actions after the Primary ABCDs have been enacted and an AED or Manual Defibrillator arrives and a shockable rhythm (VF or PVT) is present:
SCREAM
  Intervention

Note

S
Shock
 360J* monophasic, 1st and subsequent shocks.
(Shock every 2 minutes if indicated)
C
CPR
 After shock, immediately begin chest compressions followed by respirations (30:2 ratio) for 2 minutes.
(Do not check rhythm or pulse)
R
Rhythm
 Rhythm check after 2 minutes of CPR (and after every 2 minutes of CPR thereafter) and shock again if indicated. Check pulse only if an organized or non-shockable rhythm is present.

Implement the Secondary ABCD Survey. Continue this algorithm if indicated. Give drugs during CPR before or after shocking. Minimize interruptions in chest compressions to <10 seconds. Consider Differential Diagnosis.

E
Epinephrine
 1 mg IV/IO q3-5 min. Or vasopressin 40 U IV/IO, once, in place of the 1st or 2nd dose of epi.

A
M

Antiarrhythmic
Medications

Consider antiarrhythmics. (Any Legitimate Medication)
Amiodarone 300mg IV/IO, may repeat once at 150mg in 3-5 min. if VF/PVT persists or
Lidocaine (if amiodarone unavailable) 1.0-1.5 mg/kg IV/IO, may repeat X 2, q5-10 min. at 0.5-0.75 mg/kg, (3mg/kg max. loading dose) if VF/PVT persists,or
Magnesium Sulfate1-2 g IV/IO diluted in 10mL D5W
(5-20 min. push) for torsades de pointes or suspected/ known hypomagnesemia.

* Biphasic energy level is device dependent, follow the manufacturer's recommendation. If recommendation is unknown, use 200J for 1st shock and the same or higher energy level for subsequent shocks.

Algoritmo-2005-GIF