The V-Fib/ Pulseless V-tak Rap

Oh, my back's against the wall
Tryin' to learn the new ACLS protocols
I try and I try but I can't call back
The sequence for V-Fib or a pulseless V-Tak.
So I've written this verse to help me memorize,
sing along with TOO LIVE NURSE and you will be so wise.

V-Fib...Pulseless V-Tak

Now if you see somebody in a full arrest
And his heart ain't a-thumpin' within his chest
Check the pulse carotid and if it is not found,
do CPR ‘till the paddles are down...
When you finally get a defibrillator, check the monitor rhythm
Do it now...not later If you see V-Fib or V-Tak then you
defibrillate at 200 Joules.
Check the screen as you charge for the second blast.
If he's converted to a rhythm well then that's a gas.
But if V-Fib persists you know that ain't cool.
So shock-shock-shock is the golden rule.
If he won't convert
just go up on the juice...
Two to three Hundred for the second boot.
Then turn the dial to 3-6-0
and zap again to make the pulse go.
We're movin' right along but it behooves to learn,
you take a different gig entirely if Hypothermic.

V-Fib...Pulseless V-Tak

Now that you've come this far it should be plain to see...
You're faced with one of four possibilities.
V-Fib might persist, despite your zap attack.
Or happily you find their ciculation's back.
They could go Asystolic, that straight line is drawn,
or dig on P.E.A. but that's another song.

V-Fib...Pulseless V-Tak

If there's still no pulse continue CPR
Get an IV in and you will be a star.
Grab the tube, get the lube, Oh Yeah,
man this is great!
I think it might be time for you to intubate!
Give ‘em EPINEPHRINE, give ‘em 1mg.
each 3 to 5 minutes give it IVP...
If you push to no avail and V-Fib you still see,
try doses classified into a class Iib...
INTERMEDIATE...like 2 to 5 mg.'s
Ev'ry 3 to 5 minutes in the IV please.
Or pop ‘em 1 then 3 then 5 and then 3 minutes wait...
that's the way we like to ESCALATE.
Ev'ry 3 to 5 minutes you could also try point 1 mg. per kg. that's a dose that's HIGH...
If he's Hyperkalemic it's appropriate
to give 1 Meq per kg. of BICARBONATE.

V-Fib...Pulseless V-Tak

If you try EPINEPHRINE and things still ain't cool...
Defibrillate at 360 Joules.
The threshold to De-Fib may just have been reduced
and you're hopin' he'll convert when you apply the juice.
But his trunk is mottled , his naibeds blue...
use a different drug that's the thing to do.

V-Fib...Pulseless V-Tak

Now if you zapped, yeah you zapped and your zap's in vain,
try 1.5 mg.'s per kilogram of LIDOCAINE.
Ev'ry 3 to 5 minutes now repeat the dose
or the pearly gates will be getting close.
Remember now, the Lido is a IIa mode.
3 mg.'s per kg. is the total load...
After Lido is inside, Oh, and V-Fib's not done,
give 5 milligrams per kilo of BRETYLIUM...
in 5 minutes re-bolus but double the mg.'s
then try PRONESTYL for V-Fib refractory.
30 mg.'s for each minute in a drip IV
To a max of 17 mg.'s per kg.

V-Fib...Pulseless V-Tak

Now let's keep on movin' Ooh, we're far from done,
time to open up the SULPHATE OF MAGNESIUM
for torsades de pointes or if V-Fib won't quit.
If he's Hypomagnesic it might turn the trick.
1 to 2 Grams in a drip IV
Hang it up before he's discharged celestially!

V-Fib...Pulseless V-Tak

Now we used to say Bicarb was not recommended,
but it's classes and it's usefulness has been amended.
1 Meq per kg. in the IV way could be probably helpful as a class IIa.
It could alka-lize the urine in a drug OD
or could be helpful if he overdosed tricyclically,
And if it's known that his condition has been acidotic
and it's Bicarb responsive, then you must get on it!
IIb or not IIb...well is he intubated?
Has arrest been prolonged? Just how much time's abated?
Even if his pulse returns spontaneously
if he's been under awhile Bicarb's class IIb.
It's not indicated and it might do harm
if lactic acidosis makes it lose it's charm.
In such a case it's out of place and if you use you're crazy!
It's a mean class III and he'll be pushing up daisies!

V-Fib...Pulseless V-Tak

So you've tried all the drugs of likely benefit
V-Fib is still present and you're dissed by it!
So give another boot at 360 Joules
half a minute to a minute after drug's the rule
Then go DRUG-SHOCK...DRUG-SHOCK...sing and learn
and shout for joy when his pulse returns!

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