Could anyone help me better understand this code ?

Published

Pt had a-line and AICD

suddenly his abp mean dropped to 22, waveform became flat. However, HR on the monitor was 112, showing v tach on the monitor

is the pt pulseless ?

CPR first or shock?

any additional assessment needed in this situation?

Is AICD supposed to be installed for v tach?

give adenosine or other meds?

any input would be greatly appreciated.

Up Vote Up Vote ×
Specializes in NICU, ICU, PICU, Academia.

If the waveform is flat- he's pulseless. CPR while you get ready to shock. Adenosine is not for VT- it's for SVT.

112 is a little slow for VT

Sounds like the AICD is not working- was it new?

Up Vote Up Vote ×

Sounds like homework!

Up Vote Up Vote ×
Specializes in ICU.

Can you actually *FEEL* a pulse? Art lines are great, but they do go bad.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Pt had a-line and AICD:

Was the AICD new? What was the history of the patient? What meds were they on? Why were they in the ICU?

suddenly his abp mean dropped to 22, waveform became flat.

This could be for many reasons...his wrist was bent (if it was in the wrist) The waveform dampened (flush line) or the patient has no pulse. (check carotid/peripheral pulses...never trust the monitor).

However, HR on the monitor was 112, showing v tach on the monitor

What do you know about V.Tach

[TABLE=class: toccolours]

[TR=class: hiddenStructure110-250 bpm]

[TD]Ventricular rate [/TD]

[TD]110-250 bpm [/TD]

[/TR]

[TR=class: hiddenStructureregular]

[TD] Regularity[/TD]

[TD]regular [/TD]

[/TR]

[TR=class: hiddenStructureventricles]

[TD] Origin[/TD]

[TD]ventricles [/TD]

[/TR]

[TR=class: hiddenStructureAV-dissociation]

[TD] P-wave[/TD]

[TD] AV-dissociation [/TD]

[/TR]

[/TABLE]

is the pt pulseless ?

Not all V.tach is pulseless. Do know whether a patient is pulseless palpate a carotid pulse.

CPR first or shock?

Have you taken ACLS? What is the protocol for pulseless V.Tach?

any additional assessment needed in this situation?

Always remember the ABC's Airway breathing circulation. What are the patients recent labs? What is their diagnosis? What meds are they on? Is the patient dig toxic? Hypoxic? Having a MI? Have they sustained a chest trauma? Have they had a recent cardiac procedure?

Is AICD supposed to be installed for v tach?

Installed...that's cute. The AICD can be placed for many reasons. What do you know about a AICD? It is placed for patients that have recurrent arrhythmia. THey have specific settings and the patients present rhythm might be outside of the pacers parameters. What were the patients parameters?

give adenosine or other meds?

Back to ACLS...what is the algorithm or protocol for pulseless V.Tach?

Up Vote Up Vote ×
Specializes in Cardiovascular.

First question I have is whether the patient is stable or not. Patients with wide complexes can be stable. If patient is unstable and complex wide then CPR then defib. The AICD may be set to trigger at higher rates then just 112 regardless of the complex. Never wait or anticipate an internal defibrillator to shock for you especially if patient is unstable.

Up Vote Up Vote ×
Specializes in Quality, Cardiac Stepdown, MICU.
First question I have is whether the patient is stable or not. Patients with wide complexes can be stable. If patient is unstable and complex wide then CPR then defib. The AICD may be set to trigger at higher rates then just 112 regardless of the complex. Never wait or anticipate an internal defibrillator to shock for you especially if patient is unstable.

I had a pt with an AICD that coded (PEA), and about 10 minutes after we pronounced him, it fired. Scared the crap outta me while I was doing my postmortem care!

Up Vote Up Vote ×
Specializes in ICU.

Once had a VAD pt in slow VTach for a WEEK. :confused: Rhythm was unresponsive to all therapies, but the VAD still kept pumping so BP was fine. Final outcome not good. Crazy stuff.

Up Vote Up Vote ×
Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..
I had a pt with an AICD that coded (PEA), and about 10 minutes after we pronounced him, it fired. Scared the crap outta me while I was doing my postmortem care!

Hahaha delphine22.....that brings up some memories. ..very creepy

Up Vote Up Vote ×
Specializes in Critical Care, Cardiac.

Sounds like this patient went into a Pulseless VT that was below the detection rate of the AICD. Each AICD is programmed for a specific VT/VF "zone" that requires a specific rate and run count to activate the ACIDs set response. The patient can be running along in VT at 110bpm but if the low rate threshold is 120bpm the AICD will do nothing. Patients loaded up on antiarrhythmics can go into VT at slower rates. Most of the time this is fairly well tolerated but other times it can result in an arrest. Standard ACLS. Ask the MD about throwing a magnet on.

Up Vote Up Vote ×
+ Join the Discussion