Pulseless patients: shock or drugs

Specialties Emergency

Published

When coding a pulseless patient in VT or VF do you generally shock them first or use drugs in your practice?

thank you 11, I am definately not condoning any RN taking an ACLS course and being able to call themselves a paramedic. I do, however, feel that it's possible for experienced critical care RN's to become great medics through an abridged paramedic course once they have taken an EMT-Basic class and have pre-hospital experience, speaking from both the EMS and hospital side of the equation.

There goes the "RN" thing again. "Experienced critical care RN's". I challenged the Paramedic exam as An OH MY GOD LVN and PASSED!!!! So don't sit there and say, experienced critical care RN's may be able to bridge to Paramedic, blah, blah, blah,. That just shows you my point. There are too many people out there who rely solely on titles and not experience. BTW, how many NREMT-P's do you work with that are still clueless? I know tons of them. Knowledge and Experience count, not titles, and certqinly not just being able to pass a test. FYI, I'm speaking on both sides of the equation too, 5+ years in E.D., 2 years in Level I Trauma Center (S.I.C.U.), as well as 4 years as CCEMT-P, and 2 years as a flight medid, and an RN with CEN, CCRN, ACLS, TNCC, PALS, NRP, ABLS, and whatever other abbreviations you can think of.

People need to get over themselves and quit saying things like "it's possible for EXPERIENCED RN's to become medics, blah, blah, blah. Again, I don't care what abbreviations you have behind your name, the ability to use those skills, and to have actually been in those situations to use those skills, that's what matters.

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There goes the "RN" thing again. "Experienced critical care RN's". I challenged the Paramedic exam as An OH MY GOD LVN and PASSED!!!! So don't sit there and say, experienced critical care RN's may be able to bridge to Paramedic, blah, blah, blah,. That just shows you my point. There are too many people out there who rely solely on titles and not experience. BTW, how many NREMT-P's do you work with that are still clueless? I know tons of them. Knowledge and Experience count, not titles, and certqinly not just being able to pass a test. FYI, I'm speaking on both sides of the equation too, 5+ years in E.D., 2 years in Level I Trauma Center (S.I.C.U.), as well as 4 years as CCEMT-P, and 2 years as a flight medid, and an RN with CEN, CCRN, ACLS, TNCC, PALS, NRP, ABLS, and whatever other abbreviations you can think of.

People need to get over themselves and quit saying things like "it's possible for EXPERIENCED RN's to become medics, blah, blah, blah. Again, I don't care what abbreviations you have behind your name, the ability to use those skills, and to have actually been in those situations to use those skills, that's what matters.

Ok, i just have to point this out, I never once threw out credentials, or letters behind my name... you just said "People need to get over themselves...I don't care what abbreviations you have behind your name" yet you are the one who listed this: "5+ years in E.D., 2 years in Level I Trauma Center (S.I.C.U.), as well as 4 years as CCEMT-P, and 2 years as a flight medid, and an RN with CEN, CCRN, ACLS, TNCC, PALS, NRP, ABLS, and whatever other abbreviations you can think of."

I said RN because I have personally never heard of a program that has a LPN/LVN to Medic program, but I am aware of multiple RN to medic programs. So, it wasn't me trying to be rude about anything, it was I was unaware such a program existed.

Now, follow your own advise, and get over yourself.

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Specializes in ER.
The reason I ask is because I saw a relatively healthy person suffering acute illness shocked after going into pulseless VT at around 160 bpm. The initial shock converted him into VF than asystole. He died after continued resusitation attemps.

First, maybe I'm misunderstanding...maybe I'm not...however...if you could see that the HR was 160...it wasn't VT...PEA maybe...not VTach...in which case, treat the cause....hypovolemia, hypo/per thermia, high K, PE, etc, PEA is not a shockable rhythm...you can try pacing it, but not shockable...the reason the pt went into VFib after shocking possibly could have been because they were shocked inappropriately, maybe they did have a pulse and should have been cardioverted instead...when it comes to Pulseless VT/VFib...Shock first...

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Yes, the patient was pulseless VT and the initial 50 synchronized joules did send them into pulseless VF.

First, maybe I'm misunderstanding...maybe I'm not...however...if you could see that the HR was 160...it wasn't VT...PEA maybe...not VTach...in which case, treat the cause....hypovolemia, hypo/per thermia, high K, PE, etc, PEA is not a shockable rhythm...you can try pacing it, but not shockable...the reason the pt went into VFib after shocking possibly could have been because they were shocked inappropriately, maybe they did have a pulse and should have been cardioverted instead...when it comes to Pulseless VT/VFib...Shock first...
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Specializes in ER.
Yes, the patient was pulseless VT and the initial 50 synchronized joules did send them into pulseless VF.

If the pt is PULSELESS VT what did you syncronize?? There is nothing to syncronize..that's called a code....At best I can give you a is a wide complex PEA maybe...You can cardiovert the pt when VT or a wide complex tachycardia has a pulse...otherwise, you defib...check the algorithims..

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What is this alternating abdominal compression thing about? I vaguely remember reading about it somewhere but couldn't find anymore info when I looked it up. Could someone please explain?

Thanks.

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What is this alternating abdominal compression thing about? I vaguely remember reading about it somewhere but couldn't find anymore info when I looked it up. Could someone please explain?

Thanks.

Its becoming more popular.....Its in the BLS for HCP student textbook. You get better cardiac output with the alternating chest and abdominal compressions.

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If the pt is PULSELESS VT what did you syncronize?? There is nothing to syncronize..that's called a code....At best I can give you a is a wide complex PEA maybe...You can cardiovert the pt when VT or a wide complex tachycardia has a pulse...otherwise, you defib...check the algorithims..

Im sure theres more to the scenario then we are getting.......The energy setting is wrong as well......You'd start with 100 joules (cardioversion).....So something must be missing.

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Specializes in ER.
Its becoming more popular.....Its in the BLS for HCP student textbook. You get better cardiac output with the alternating chest and abdominal compressions.

It's actually pretty old school...however there have been studies that show it is no more effective for cardiac output then regular compressions...and you look silly doing it...

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Specializes in ER.
Im sure theres more to the scenario then we are getting.......The energy setting is wrong as well......You'd start with 100 joules (cardioversion).....So something must be missing.

You are right Bob, unless the pt is in Aflutter or PSVT, then you can try 50J the first time...but most people start at 100J, unless its biphasic..then its 70J

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First stop the RN- Medic- LPN pissing contest. All three have their own place in a healthcare team. There are competant and incompetant Medics EMTs Nurses etc There Are even some MDs I would not want getting within ten feet of my parents.

Second, Cardiac Care like most of medicine is an art. Yes ACLS recommends certain energy settings but depending on the experience of the provider these may be changed. There are plenty of ACLS recommendations that I have modified to treat patients. For example 100J monophasic Sync. is the recommended starting energy for Stable v-tach. I have started at settings of 50 or even 25 and have been successful. Another good one I always like to bring up is that ACLS says a levophed(norepi) drip should be started on a CHFer with a SBP under 70. A CHFer already as a high SVR and therefore becayse norepi has relatively low Beta stimulation Relative to its Alpha effects it might bring BP up but there would be no significant forward flow/cardiac output

third, unfortunately Sudden V-tach in young otherwise healthy individuals does happen all too often. It usually stems from some kind of conduction abnormality such as a prolonged QT interval. This coupled with vigorous physical activity may cause bouts of V-tach or Torsades.

Rant Off

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A man starts the post and asked a question (which appeared to be in good faith) so he could learn something and look how you all responded...... Talk about "nursing eating their young". Incredible..... I thought nurses and medical personnel would share the wealth of knowledge and provide their experience in a mentoring manner in order to facilitate patient care and safety. The overall response to his question was quite trite and ridiculous.

Just what I see,

Mike

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