V-tach/PVC question

  1. Ok- figured I'd get more folks to answer here. I'm a new grad, tonight was my second night off of orientation. I know there is always someone there if I need them though. I loved cardiac, knew my rhythms, and thought I'd be confident of what I saw when I saw it.
    I was in a patients room, charting something, went to chart his vital signs, and noticed his HR had went to 130's (had been 90'). Guy was there for chest pain, negative enzymes, but significant cardiac history. I look at the monitor and notice the rhythm looks way different than it did before (I'll try and scan a copy later). Then he has a PVC, and has about 8 of them. My understanding of PVC's was that once you hit 3-4 in a row, it basically becomes a run of v-tach? This is where I am getting confused. So MY heart starts racing, I look at him, he's awake, breathing, says he feels the same. Then he goes back into a NSR. WEIRD!!!
    Was what I saw v-tach? I was watching it, and by the time I realized that was what I thought I was looking at, and had asked him how he was, it was gone. The machine only recorded the funky rhythm before (which the machine called v-brady). Is v-brady a v-tach that is just not above 100bpm?
    I'm dying to take ACLS, but have been told it will probably be next year before I can take it. I feel so lost sometimes, and I did awesome in cardiac (and loved it)! TIA-Andrea
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  2. 9 Comments

  3. by   HawaiiRRTRN
    Aneroo,

    Yep, sounds like you witnessed a run of stable v-tach. If your patient is still breathing and conscious, no immediate tx is needed. Of course if he loses consciousness and stops breathing, immediately call a code.

    ACLS will help you immensely as these situations and treatment for them are discussed specifically. You should see about getting into a class sooner if possible, especially if your working on a cardiac floor.

    Good luck to you.
    HawaiiRRTRN

    Quote from Aneroo
    Ok- figured I'd get more folks to answer here. I'm a new grad, tonight was my second night off of orientation. I know there is always someone there if I need them though. I loved cardiac, knew my rhythms, and thought I'd be confident of what I saw when I saw it.
    I was in a patients room, charting something, went to chart his vital signs, and noticed his HR had went to 130's (had been 90'). Guy was there for chest pain, negative enzymes, but significant cardiac history. I look at the monitor and notice the rhythm looks way different than it did before (I'll try and scan a copy later). Then he has a PVC, and has about 8 of them. My understanding of PVC's was that once you hit 3-4 in a row, it basically becomes a run of v-tach? This is where I am getting confused. So MY heart starts racing, I look at him, he's awake, breathing, says he feels the same. Then he goes back into a NSR. WEIRD!!!
    Was what I saw v-tach? I was watching it, and by the time I realized that was what I thought I was looking at, and had asked him how he was, it was gone. The machine only recorded the funky rhythm before (which the machine called v-brady). Is v-brady a v-tach that is just not above 100bpm?
    I'm dying to take ACLS, but have been told it will probably be next year before I can take it. I feel so lost sometimes, and I did awesome in cardiac (and loved it)! TIA-Andrea
  4. by   Aneroo
    I work in the ER. I bug my educator all the time about it (I want ACLS! I want PALS! I want TNCC! I want, I want, I want!!!) There is such a large influx of new RN's at this time of year, it's hard to get in. So all the folks on the cardiac floors and ICU's are going first. I understand, as I have tons of rn's and docs on hand who are there as soon as I can yell "help!". But darn, I'm impatient! lol Thanks for the quick reply and reassurance.
  5. by   Daytonite
    Sounds like the patient may have had a short run of PAT (paroxsymal atrial tachycardia) and then flipped back to NSR?

    3 PVCs in a row is a short run of V-Tach (we called it Baby V-Tach). He is going to be awake and breathing because he still has blood perfusing in his brain tissue. Did he have the 8 PVCs in a row? If not, I've seen lots of patients having more than 20 PVCs a minute who are still alert with no disruption of consciousness. Your monitors should be set to alarm at a brady rhythm. We set ours at 50. You will get a brady alarm on runs of V-tach if they last a few seconds because the monitor is detecting the slow ventricular beat. Run a strip of those runs of PVCs and use your calipers to measure and calculate their rate. They will most likely be in the range or 40 or so. When the ventricle initiates the heart beat, the beats are much slower because the electrical impulse goes a namby-pamby route to get to the perkinge fibers to cause the muscular contraction of the ventricle. The atrial pacemaker is much faster and far more efficient (SA node to AV node to perkinge fibers then the muscular contraction). However, when the SA node fails to generate an electrical impulse the AV node will compensate and generate an electrical impulse. When the SA and AV nodes fail, ventricular cells will start to generate an electrical pulse that is very, very slow. Those are your PVCs. Sustained PVCs are ventricular bradycardia. The heart cannot maintain that condition for very long so they have to be treated.

    One of the things you will learn in your EKG class is how the electrical system of the heart works and how glictches in it generate all the various dysrhythmias.
  6. by   hrtprncss
    When that happens out of the blue one of the things you can do after you've assessed your patient and make sure that he's alright is go back on the chart, check the mounted ekg's to see if it has happened before...Check that day's labs and make sure that they're wnl. then afterwards you can decide wether to resend labs, call the md, or watch the patient.
  7. by   Mandarella
    Hey Aneroo,

    Voting for a run of v-tach also. <150 we consider slow VT, if it's 30 sec or more it is referred to as sustained.

    I am not yet a nurse, I am a monitor tech on a critical unit. I have an amazing reference book that I bought when I first started- I still use it!! LOL. It's called desktop cardiac reference, it explains heart rhythyms, tests, procedures, diseases, terminology etc. Even has lab values. The web address on the book says www.cardiacreferencebook.com if you are interested.

    Good luck being patient!! I know how that goes
  8. by   Aneroo
    Thanks you guys. It scared me to death!
    Yes, it was about 8 PVC's in a row. I didn't count them as it was happening, figured the monitor would record it- it didn't!
    Yes, once I saw what was happening, I looked at him and asked him how he was doing. I was in the mode of prepping to throw the stretcher back, check pulse and holler for help. (We were all jumpy, they had just had a patient code in the back a little bit earlier- sure that full moon was this weekend?)
    lol
    Thanks for the replies. I have been through a basic dys class, and did feel really confident about my EKG skills. I just figured the monitor would record something that significant, and maybe I only THOUGHT I knew something.
  9. by   Jen87
    We learned about pvc and v tach today and our instructor said she had a patient who was in v tach for 30seconds answer was walking and talking, just felt dizzy dt lack of perfusion. So i guess it can happen!
  10. by   beckster_01
    We call them run PVC's on my floor, but our providers are very adamant that it is not and cannot be V-tach unless it is tachy. Less than 100bpm is NOT VT. I'm sure you can call it v-brady or slow VT or whatever, but it tends to look distinctly different from true VT. Regardless I still like to grab a set of vitals and check on the patient, but at least with my patient population it tends to be asymptomatic and a result of the manipulation of the heart during surgery.
  11. by   turnforthenurse
    Sounds like you witnessed a burst of non-sustained V-tach. Non-sustained meaning the patient converted back to their rhythm and it lasts <30 sec. >30 sec = sustained V-tach.

    First and foremost, assess the patient. Are they hemodynamically stable? Then check your labs (especially your electrolytes) to see if they are WNL. Electrolytes that are out of whack can = dysrhythmias! I personally would call the MD and let them know that it happened, but report that the patient is fine, etc.

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