ABC of resuscitation. Ventricular fibrillation

The hopeful phase: three shocks at 160J, 160J, 320J (200J, 200J, 400J). The struggling phase: three shocks at 320J (400J) after, respectively, lignocaine, adrenaline, bicarbonate. Patient intubated if possible. The desperate phase: three shocks at 320J (400J) with different electrode position or different defibrillator. While improvements will doubtless be made as skill in resuscitation increases, the guidelines can ensure that relatively few treated patients die in ventricular fibrillation and only those with irreversible myocardial damage are likely to be converted to intractible asystole.