VTACH

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    Hello,
    Im not sure if this is the right place for this question, but here it goes. I am fairly new to the hospital setting on a tele unit. This may be a siI mple, should know, question, but I didnt know where else to ask it. I had a pt who had been running NSR for three days. Out of the blue, she had a 12 sec run of vtach 27 beats long. I work night shift and calling the docs in the night is allways a stressful thing for me. I was fortunate to have a strong nurse working with me that night, and helped me with calling. I guess most docs want to know in few words what is wrong and what you want. The problem being, most of the time I cant figure out what I want, I thought that was why they were the docs? Anyway, I called and explained she was asymtomatic, had been asleep at the time, vs were stable, her potassium was borderline at 3.6 and no mag had been checked since her admission. I also let him know whe was not on a beta blocker. He ordered a mag and x1 postassium 20meq po, he also asked me if she had any resp issues. Im not so sure why he wanted to know this except to decided on the beta blocker? She was in with bronchitis and has a hx of asthma. The mag came back good at 2.0, what other reasons for this sudden burst of vtach? Was the question for respiratory r/t beta blocker? I struggle to know what to know before I call, it seems no matter how much info Im ready to give, they allways find another question I didnt expect. Im sorry if this is so basic, but I am trying to learn the best I can.
    Any good interactive websites, pay or free, for cardiac knowledge/arrythmias? I learn best buy interaction...
    Thanks soo much!
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    Without knowing more, I'd guess the doc was concerned about any hx of COPD/asthma. Look up selective vs. non-selective beta blockers and that might help explain things.

    In our patient population, post-cardiac surgery patients, we keep our potassium levels closer to 4.5 and magnesium levels closer to 2.5, sometimes even 3.0. We've found that for our patients, these level help minimze arrhythmias. We also check ionized calcium levels, (regular calcium levels you need to correct to get a true level, just easier to check ionized). On the floor, we supplement calcium with calcium gluconate, in the ICU (where we have usually have central access) we use calcium chloride.

    What specifically are you looking for re: cardiac knowledge/rhythms? Are you looking to practice reading rhythms or treating them? I have some great references I can share with you but need a better understanding of what you're looking for.

    As for what to say when you need to call a doc, you need to remember to paint the picture for the doc...he/she can't see what you're seeing, so you need to be as clear as possible. If you see an arrhythmia, you need to explain the type, VS, was the patient symptomatic, labs available, that kind of thing. It also helps if you are able to have a better understanding of the pt's history (for example, are they in heart failure? that may change the management of the situation. Do they have renal failure? An elevated creatinine may change how you dose electrolyte replacement.) Do you see where I"m going with this? The doc you call at 2 am may not have the pt's history available to them, so you want to be armed with as much info as possible.

    I'll share one reference really quick: Kathy White's Fast Facts for Adult Critical Care. Very reasonably priced IMHO, has tons of info that is in a small binder that actually fits in your pocket. She has a great section on rhythms and ekg's. I've used her book for years, first as a learning tool now as a teaching tool.
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    I'm guessing another reason the doc asked about respiratory status is that poor oxygenation can lead to ventricular arrhythmias - I've seen it frequently in people who have undiagnosed sleep apnea. SaO2 is one of the first things I check when I have a patient with runs of v-tach or increasingly frequent PVCs (along with the other culprits, like K and Mg - but SaO2's something I can do at the bedside. .


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