V-tach

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    Last night I was informed by tele that my pt had a run of V-tach. I went to go check on him and luckily for me and the pt, the doctor was already in there rounding on Mr.P. Long story short--the doctor ordered a STAT 12-lead EKG. The results came back showing little spurts of v-tach at a rate of 101. I know, not really tachy. The doctor wasn't too concerned about it. He told me he thought the rhythm was chronic, and nothing else was said or done about it. Was he right? Can V-tachycardia be a benign underlying rhythm? And my biggest question--how can you tell a rhythm is chronic by looking at a 6-second strip????
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  3. 5 Comments so far...

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    You can't tell a rhythm is chronic by looking at the EKG or strip. If the doc knows his history he would be able to know if this is chronic for this pt or not. Does the pt have an ICD? That could be why the doc didnt seem to care. Some pts especially those with low EF's can have runs of vtach without symptoms. Hopefully the pt is on an antiarrhythmic if he does this often. Also look at the elytes. Is his K or Mag low? Has the patient been receiving diuretics without k replacement? did the pt recently have a cardiac cath? Pt are more susceptible to arrythmias post cath.
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    Quote from gwendelyn
    Last night I was informed by tele that my pt had a run of V-tach. I went to go check on him and luckily for me and the pt, the doctor was already in there rounding on Mr.P. Long story short--the doctor ordered a STAT 12-lead EKG. The results came back showing little spurts of v-tach at a rate of 101. I know, not really tachy. The doctor wasn't too concerned about it. He told me he thought the rhythm was chronic, and nothing else was said or done about it. Was he right? Can V-tachycardia be a benign underlying rhythm? And my biggest question--how can you tell a rhythm is chronic by looking at a 6-second strip????
    Without seeing the 12 lead, it's tough to talk about the rhythm.
    Many times the telemetry equipment is "fooled" by various intraventricular conduction delays. I don't know how many times I've seen an alarm say V-tach when it's actually a-fib with a R BBB. Technically, a rate of 101 isn't v-tach. The MD saying it was chronic also makes me think that it's probably a BBB, but without seeing the strip....
    V-tach is not a benign underlying rhythm, it's always potentially lethal (even though some people are hemodynamically stable in v-tach and can stay that way for awhile) but if it's sustained you want to get rid of it asap.
    for your biggest question: the only way you can tell a chronic rhythm by looking at a strip is if you've seen a previous tracing from the patient and it was the same thing. but just looking at 6 seconds (or 10 seconds in the case of a 12 lead) you don't know anything except what's happening electrically during that time frame.
    Hope this helps some.
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    How long were the runs of VT?
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    Actually, I did hear the cardio/pulmonary therapist--the guy doing the strip--say it looked like a BBB. I didn't put 2 and 2 together until getoverit mentioned it.

    This has to be what happened. I doubt the doctor and the techs would have brushed this off if it was really V-tach. The next time I see the doctor I will ask him about it.

    Thanks for the input!
  8. 0
    Oh yea, BBB slipped my mind too. Our monitors do that all the time too. That would explain why he said it was chronic.


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