Longest run V-tach?

nilepoc · Oct 21, 2002

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

Andy S., BSN, RN · Oct 21, 2002

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?

NurseBoricua · Oct 21, 2002

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. :devil:

codebluechic, ASN, RN · Oct 21, 2002

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. :eek:

CCURN · Oct 21, 2002

A patient once had v tach for an hour, became symptomatic and had to be cardioverted

ERNurse752, RN · Oct 21, 2002

I also took care of a guy in constant VT...he felt fine...much better than we did!

bestblondRN · Oct 21, 2002

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 :)

NicuGal, MSN, RN · Oct 22, 2002

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!

MollyMo · Oct 22, 2002

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.

RoadRunner · Oct 22, 2002

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... :rolleyes:

Jas honey · Oct 22, 2002

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)