okay in our video series of ECG interpretation Made Easy in this video we are going to talk about a very high yield ventricular Rhythm called as ventricular fibrillation ventricular rhythms are divided into premature ventricular complexes ventricular tachycardia and ventricular fibrillation in this video we are going to talk about ventricular fibrillation I have already made videos on premature ventricular complexes and ventricular tachycardia the blink of those videos is given in the description below now what is ventricular fibrillation ventricular fibrillation is a chaotic firing of multiple ectopic Foci in the ventricles normally in our heart essay node produces electrical currents and those electrical currents cause contraction of the Atria these electrical currents travel through the internodal pathways to the AV node and AV nodes send these signals through the bundle branches to the purkinje fiber and purkanji fibers cause contraction of the ventricles now what happens in ventricular fibrillation is that there are certain ectopic Foci present in the ventricles these ectopic Foci generate electrical activity they generate abnormal electrical activity and cause contraction of the ventricles and Atria they take over the normal pacemaker activity of SA node they compete with SA node and they win the fight between SA node and these ectopic Foci these ectopic Foci generates so much current that literally The ventricle goes into seizures like this the ventricles do not contract properly The ventricle C is due to electrical activity the ventricles are literally on fire with this much electrical activity these multiple ectopic Foci are producing electrical currents that chaotic firing of multiple ectopic Foci in the ventricles that totally disturbs the electrical activity of heart that is called as ventricular fibrillation are present in the ventricles producing abnormal electrical currents and abnormal electrical activity in the heart resulting in seizures of The ventricle the ventricles are seizing what you see on ECG is also an abnormal Rhythm an abnormal Rhythm like this which makes no sense there is no qrst wave because everything is gone everything is abnormal everything is haphazard the electrical Rhythm that you see on ECG is also very haphazard that is a ventricular fibrillation and as soon as the patient develops ventricular fibrillation within seconds the amount of blood pumped to the body diminishes to zero remember the heart is Contracting normally in a synchronized Manner and all of a sudden these ectopic Focus start generating abnormal electrical activity and these ventricles start seizing like this and when the ventricles are seizing they are not Contracting properly and they are not pushing out the blood from the heart therefore the cardiac output diminishes down to zero the cardiac output is zero you will see no pulses the patient will get unconscious within seconds the patients will deteriorate therefore this is a very lethal thing if there is no intervention done if if the patient is not many this is one of the most common cause of death after Mi one of the most common cause of death in pre-hospital setting it is the most common cause of cardiac arrest in patients this is an ECG showing chaotic Rhythm ventricular fibrillation this is the ventricular fibrillation this ventricular Rhythm makes no sense there are no p waves there are no QRS complexes this is an abnormal electrical activity because multiple Foci are on fire and they are fighting with each other and there is no proper electrical activity running in the heart this is another ECG showing ventricular fibrillation this is another ECG of ventricular fibrillation so these are all the forms with which ventricular fibrillation can present to you now previously we discussed all different types of PCGS even though the rhythms were Disturbed even though there were blocks even though there were abnormal ectopic Focus but somehow The rhythms made some sense this makes no sense the ventricular fibrillation is so haphazard that you see a rhythm like this now a classical presentation of a patient with ventricular fibrillation would be that the patient would develop chest pain shortness of breath palpitations dizziness and within seconds the patient will deteriorate within seconds the patient will lose Consciousness there will be no pulses the pulses will be absent and the patient will be unconscious and if you do not intervene at this point the patient will die if you do not manage the patient the only management of ventricular fibrillation is defibrillation what you do is that you start the CPR you defibrillate the patient that's the only treatment we will talk about the treatment in a while now the causes of ventricular fibrillation coronary artery disease is most common cause previous Mi previous Mi myocardial infarction tissue the damaged heart tissue has the ability to generate abnormal rhythms these are the ectopic Foci these are the center of ectopic Foci and even within first 24 hours after Mio ventricular fibrillation is the most common cause of death because these ectopic poki generate abnormal electrical activity and they can lead to death of the patient therefore we give beta blockers after an MI to prevent these type of ventricular fibrillation electrolyte imbalances hypokalemia hyperkalemia electrophysiologic disorders wolf perfumes and whites and Rome long cute interval the most common cause is a hard damage if the patient is having my a previous Mi if the patient is having myocardite as if the patient designing congestive heart failure these heart failure patients have a damaged heart their heart has different changes in them their heart is either hypertrophic their arabinalities present in the heart and whenever there is any change from the normal tissue there is a change in the electrical activity and there is a risk that that patient will develop ventricular fibrillation now coming to the normal characteristics of ventricular fibrillation the heart rate is not measurable because there is no pulse the the ventricles are seizing there is the regularity is irregular the p waves are not there the peak to qrs ratio cannot be measure the PR interval are not there the QRS complexes are not memorable that is an irregular abnormal rhythm now let's look at some ECGs if you look at this ccg this is an ECG of ventricular fibrillation heart rate unable to determine regularity irregular p waves none PR intervals none QRS complex unable to determine an interpretation is coarse ventricular fibrillation now if you label this as the ventricular fibrillation it is totally fine and if you put coarse ventricular fibrillation that's even better now else there are two types of ventricular fibrillation there can be a coarse ventricular fibrillation that has a prominent waves like these and there can be a fine ventricular fibrillation when which is more like a straight line but there are small squiggles and bumps or in it that is called as a fine ventricular fibrillation I will show you the ECG now now if you look at this ECG this is another ECG of coarse ventricular fibrillation heart rate unable to determine irregular previous none pure intervals cannot be determined unable to determine the QRS complexes coarse ventricular fibrillation now this is an ECG showing fine ventricular fibrillation which is more like a straight line remember not to confuse it with asystole asystole does not have a squiggles or bumps like these a system is more like a flat line it's almost a flat line This is basically a ventricular fibrillation this can be easily confused with this history but these these abnormal squiggles and bumps these show that there is ventricular activity and this is a ventricular fibrillation if you mark this as acetry that will be marked wrong now heart rate unable to determine regularity irregular p waves none PR interval none QRS complex is unable to determine when the interpretation is fine ventricular fibrillation now in the previous all the ECG videos that we discussed there are The rhythms that we discussed we always had something to say in these things but in ventricular fibrillation everything is abnormal now coming to the management whenever the patient develops a ventricular fibrillation either the monitor starts showing such waves or the patient becomes unconscious and you directly do put leads and you do ECG and you see these abnormal rhythms you start the ACLS protocol do not think over it start the ACL ACLS protocol start CPR start giving test compressions till the time the staff brings you the defibrillator and you follow the ACLS protocols like this now in ACLS protocol you start CPR you give oxygen you attach the Monitor and defibrillator and you see whether there is ventricular fibrillation or not if there is ventricular fibrillation or pulseless ventricular tachycardia and I have talked about pulseless ventricular tachycardia in detail in my video on ventricular tachycardia if there is ventricular fibrillation or pulseless ventricular tachycardia v-fib v-tac you shock the patient remember we FIB we attack you shock you give the shock to the patient after giving shock to the patient you again restart the CPR and then you again reassess the patient you again reassess whether the rhythm is shockable or not and then if the rhythm is shockable you again give shock to the patient now which Rhythm is a shockable rhythm and which Rhythm is a non-chockable rhythm if there is we FIB or we take that is shockable if there is a systole or pulseless electrical activity that is a non-shockable rhythm in non-shockable Rhythm you cannot do anything else other than giving epinephrine to the patient now I have talked about all these according arrest protocols in detail in my video on Cardiac Arrest management you can check out the link given in the description below no if you if you started CPR you give the shocks to the patient you again assess the Rhythm and if again the if the ECG is showing ventricular fibrillation you again shock the patient then you continue the CPR you don't bring any breaks in between you shock you do see value shock you do CPR and this time you give epinephrine 1 mg every three to five minutes and then you reassess the Rhythm that whether the rhythm is shockable or not if the rhythm is shockable if it shows will tap you again start the CPR you start just compressions you give a murderone or lidocaine to abort this Rhythm and you treat the reversible causes if at any point if at any point the Rhythm becomes non-shockable you have to shift to the other side of the graph in that case you cannot give shocks to the patient if the patient is having Asis or personalized electrical activity you cannot shock the patient in such case you can only give epinephrine to the patient and you continue doing CPR if in any case that is systole or pulses electrical activity gets converted to be FIB you shock the patient or if the patient develops a v-fib and gets converted to asystole you do CPR and you give epinephrine and remember a sisterly has very poor prognosis many patients ah majority of the patients die if they develop asystole acystole basically is no electrical activity in the heart now I'll post the whole chart of ACLS on my Facebook page the link will be given in the top comment now in the ACLS chart the dosages are as follows when you give epinephrine you give 1 mg every three to five minutes and after giving epinephrine The Next Step would be to again reassess the Rhythm and then you look go for a mild drone or lidocaine a Mito and IV first dose 300 mg bolus second dose 150 mg or if amidron is not available and the t is tension pneumothorax look for cardiac tamponade toxins pulmonary thrombosis coronary thrombosis the tease these are the reversible causes that can cause ventricular fibrillation and they must be look for when you are doing the ACLS protocol before going into the summary if you liked my video please click on the Subscribe button and check out my videos on ventricular tachycardia polymorphic ventricular tachycardia premature ventricular contractions the link of those videos are given in the description below we talked about what is ventricular fibrillation how does it appear on a CG within seconds patient becomes pulseless this is how it appears the causes of ventricular fibrillation the characteristics of ventricular fibrillation the presentation of ventricular fibrillation the ACLS chart that you have to follow when you see ventricular fibrillation on monitor the drug therapy in ACLS protocol the reversible causes if you liked my video please click on the Subscribe button and check out my other videos on ECG interpretation Made Easy the link of those videos is given in the description below thank you very much