Longest run V-tach?

  1. Had a patient on the floor tonight (not one of mine) who had runs of VT that extended to 80-90 beat runs, all the while feeling asymptomatic. She was A & O x 3. Was resting supine in bed at the time. She couldn't understand what all the fuss was about.
    "I feel fine!"

    Started with 20 beat runs of VT, and MD was rx'ing it w/ po amio.But pt then extended on w/ tons of ectopy, couplets, runs of VT 30 beat long, 50 beat...80-90 beat runs. Po amiodarone not helping, apparently. LOL! Patient feeling no symptoms during episodes. Started on Amio drip as I left. What's the longest run of VT you've seen with patient A&Ox3 & feeling fine? I'm curious!

    Strangest thing I've seen on tele in a long time.
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  2. 27 Comments

  3. by   nilepoc
    longest run, I can't say, I did however get a order from a physician that said.

    Do not call me unless the run of vt is greater than 250 beats, or symptomatic.

    that doctor is a real jerk and is a promintent tv figure where I used to live.

    BTW you don't need an order to give lidocaine, in a "code" like situation.

    Another time I took care of a patient that lived in persistent VT, so that does not count as a run.
    Craig
  4. by   Andy S.
    As long as they push a pulse right? JK

    I have heard of people being in stable VT for as long as an hour, but the pt had a pulse with it. I think they eventually shocked him out of it when he decompensated.

    Anyone thought about an AICD at this point if meds aren't helping?
  5. by   NurseBoricua
    Had pt. in ICU with ICD set at 190. Kept having runs whole dang night. Pressure stable. Hmm Amio drip not working...pulse 187..189.. 182 170 aww c'mon already shock him you dang icd. Hmm here I go again pushinhg lido. Longest I waited was three minutes. If ICD set too low...he would get shocked all night. Kept crash cart at door to ward off evil spirit...and wave lido syringe around body with fellow nurses as if we were performing an exorcism.
  6. by   codebluechic
    I had a patient that presented to the ER in asymptomatic VT. He was on a continous EKG and when his chart came up they sent it all! Pages and pages, at least 2 inches thick. Impressive.
  7. by   CCURN
    A patient once had v tach for an hour, became symptomatic and had to be cardioverted
  8. by   ERNurse752
    I also took care of a guy in constant VT...he felt fine...much better than we did!
  9. by   bestblondRN
    My dad had a run of v-tach that lasted for just short of 2 ours that were documented. He didn't decompensate, but was electrically cardioverted out of it and had an AICD/pacer implanted the next day
  10. by   NicuGal
    We had a kid in our unit that would have a run every 30-45 minutes...his HR would be 250-300, we'd push the adenosine, he'd drop back, then 30 minutes later he was doing it again. I think the kid is going to grow up with a fear of ice to his face and crotch! We finally got him stable on Amiodrione and sent him home. He got obliterated at 1 year of age. Scary!
  11. by   MollyMo
    It took about 5 minutes to hang a lido drip on a guy who kept going in and out of vtach. He just kept going and going until the lido kicked in. AAO x 3 the entire time. He had unsustained runs up to that point. But it had gone on all day. I hung the drip at night when he hit sustained vtach. The monitor tech kept hollering" he's still in it!!!" I thought she'd be next.
  12. by   RoadRunner
    I had some of those. Asymptomatic VT, wondering why everyone's asking "How are you feeling?" every two minutes!!!
    Nurses felt a lot worse...not to mention anxious!!!

    We put them on Amiodarone drip with Amio po (and hope to not use the crash cart) and make them feel a lot worse than they did on admission...


  13. by   Jas honey
    Hi all,

    I have seen people be in stable VT for several days (this was back in the early days of EP when we tried all sorts of antiarrhythmic drugs before implanting an ICD) Amiodarone PO takes several days to load, it gets absorbed in the fat, bone and other tissues before appreciable (and effective) amounts show up in the blood. So I am not surprised that they had to use IV amio. It is kind of weird and unnerving to watch VT on the monitor all the time, (but neat!!!!) and of course the increased patient assessments impact your day too! Some VTs are amenable to ablation, most arent. EP studies are the way to go for identification. ICDs arent good for people in incessant or frequent VT, all those shocks make people understandably psychotic! (not to mention the nurses too LOL)
  14. by   CATHYW
    I saw a man in VT "talk" his way into a code. The man had been having several runs of VT during the evening, but was asymptomatic. I kept him in bed, just in case, and luckily, while his MD and I were at the bedside, he started again. This time he didn't stop, though! He continued to have a BP, and was awake and oriented, but a little tired-looking. He and the MD kept talking while I got the code team from ICU to "walk over." In the few seconds it took for them to get there, his BP was not audible; only by palpation. His speech became slightly slurred, and he was down for the count! He never changed from VT, but was sent to the ICU, where a temp. pacer was inserted. That was one of the darndest things I've ever seen!

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