Longest run V-tach? - page 2
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.... Read More
Jan 22, '03Occupation: CCU RN Joined: Sep '02; Posts: 1,039; Likes: 10I saw a little old lady in stable VT for three days. She'd go in and out but for the most part she was in.
Jan 23, '03Joined: Jun '02; Posts: 311; Likes: 3Was it VT or a bundle branch block? I know it sounds stupid, but...
And trust me, I'm not doubting your ability to read a 12 lead. Just sometimes, it can be hard to tell!!
Jan 24, '03Occupation: CCU RN Joined: Sep '02; Posts: 1,039; Likes: 10Well, the entire team of CCU docs (large teaching hospital), multiple nurses who cared for the woman over her ICU stay, the EP docs, everyone was in agreement that it was indeed VT.
Jan 24, '03Occupation: Critical Care RN: Trauma ICU and air transport Joined: Dec '02; Posts: 482; Likes: 15Originally posted 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.
He eventually had an ICD put in with very high parameters, but he was discharged with the VT.
May 26, '08Joined: May '08; Posts: 2; Likes: 1I saw my longest run tonight. The patient came to the ER with 6 hours of palpitations and fatigue. He was in V tach when put on the monitor with HR 210. His lips were purple, but he was conversant and oriented (but his bp was only 70/35). He was 27 w/ history of 3 open heart surgeries for congenital heart disease. Family convinced him after the 6th hour of symptoms to go to ER... his mother was an RN too. Patient was apparently scared to go to the ER because last time he was defibrillated and this was very uncomfortable.
The adenosine we gave him did nothing of course, and since he was allergic to amiodarone per his mother, he received lidocaine 100mg IV bolus and converted to NSR. sweet.
May 26, '08Joined: Dec '05; Posts: 989; Likes: 438had a pt yesterday run about 15min in V-fib. Shocked, as I went to check on them, only to find them hooked up to a percussion vest. Was real relieved after that .
May 26, '08Occupation: RN Specialty: Critical Care ; Joined: Feb '06; Posts: 2,125; Likes: 3,657Quote from NicuGalAre you sure you didn't mean SVT?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!
Adenosine potentates an AV nodal block which would do absolutely nothing for a ventricular tachyarrhythmia*.
*some studies have shown adenosine-responsive VT in a small population of patients, but it's not part of any typical treatment plan.
May 26, '08Joined: Jun '02; Posts: 14,165; Likes: 59,216longest run of vt i've ever seen was 3 or 4 days -- ep patient. he was asymptomatic for the most part. got a little light headed after walking to the bathroom, so he sat down and forced himself to cough until he felt better. (he drove himself to the er, also -- 100 miles over gravel roads!)
longest run of vf i've ever seen was 2 1/2 weeks -- patient with biventricular assist. same patient had the longest run of asystole i've ever seen -- about six months. she got transplanted and went home with a lovely sinus rhythm!
May 26, '08Joined: Mar '04; Posts: 17,908; Likes: 37,183In 1981 we had a man in V-tack nearly the whole weekend.
He was alert and afraid most of the time.
I was an LVN assigned to sit in the room watching in case he lost consciousness. The plan was for me to push the code button, charge the defibrillator, and apply the gel. By then the team would arrive.
He was defibrillated 17 times that weekend.
Monday morning he went for a CABG.
The surgeon patched his heart muscle with thigh muscle. He said he couldn't do the graft because , "It was like trying to sew oatmeal."
That man lived many years. He rode a bike and played golf.
He died the same year his surgeon retired. He was nearing 90.
May 26, '08Occupation: H1N1 Specialty: 18 year(s) of experience in neuro, ICU/CCU, tropical medicine ; Joined: Mar '08; Posts: 503; Likes: 637Quote from ruby veea six month run of asystole? where i'm from, we call that 'death.'same patient had the longest run of asystole i've ever seen -- about six months.
it just goes to show you, treat the patient, not the monitor. i've seen plenty of people yell to defibrillate v-tach who needed to be reminded to check to see if the patient was symptomatic before they put electricity through his chest.
i've seen stable v-tach often enough that i don't think it's that uncommon.
May 26, '08Occupation: LVN in skilled nursing / rehab Specialty: 5 year(s) of experience in LTC, subacute rehab ; From: US ; Joined: Dec '05; Posts: 562; Likes: 408Quote from aeauoooPerhaps the patient was on an IABP ?A six month run of asystole? Where I'm from, we call that 'death.'
May 26, '08Occupation: RN Specialty: Critical Care ; Joined: Feb '06; Posts: 2,125; Likes: 3,657Quote from SaraO'HaraHow can an IABP inflate during diastole if there is no diastole to begin with?Perhaps the patient was on an IABP ?
The only way I can think of somebody surviving in asystole is continuous bypass or an artificial heart.
May 26, '08Occupation: H1N1 Specialty: 18 year(s) of experience in neuro, ICU/CCU, tropical medicine ; Joined: Mar '08; Posts: 503; Likes: 637Quote from methyleneNot to mention that the coronary arteries are perfused during diastole.How can an IABP inflate during diastole if there is no diastole to begin with?