Messed up my interview

jadelpn, LPN, EMT-B · Jan 9, 2016

I dunno, think basics--Rapid response, EKG, AED......as far as specific treatments, that is either facility standing orders or you need some.

Vtach is an acute emergency. I think that may have been what they were going for. Your recognition and reaction to it.

Most standards are an EKG immediately upon arrival (within 7 minutes complete in most areas)

Again a lot of "what ifs" did the patient come in with Medics who found this, walked in.....

I don't do well with generalized questions of this nature. Because there's a whole lot more to it that "what would you do if...." just remember, assess, EKG, put the pads on and get assistance pronto.

applesxoranges, BSN, RN · Jan 9, 2016

You could have said punch him.

I think most places don't let RNs do carotid massages.

To be fair, generally ACLS is too fast, too slow, no pulse. That's quick and dirty ACLS right there. Without seeing the rhythm and knowing for sure that it was vtach (granted they are telling you it is), sometimes you would try several interventions. So you technically may not have been wrong in real world. Although it could change in 2015 guidelines.

As a new grad, it is shocking that you would be able to answer that anyway. Most new grads would not. Many experienced nurses, depending on where they work, would not be able to answer that. As a new grad, most people do not have the basic ACLS down. Many experienced nurses don't have ACLS down. You attemped to answer it anyway.

AnnieOaklyRN, BSN, RN, EMT-P · Jan 9, 2016

#1 NEVER EVER DO CAROTID MASSAGE ON ANYONE (please do research on this!) There are plenty of other vagal maneuvers you can do for patients in SVT (not in VTach - see #2)

#2 Vagal maneuvers will not work for ventricular tachycardia (your ventricles are only sporificely innervated by the parasympathetic nervous system).

#3 Adenosine and Cardizem will not work on ventricular arrhythmia's, as they work on the AV node, and can cause life threatening deterioration of the rhythm in patients experiencing arrhythmia's originating in the ventricle!

# 4 he was wrong if he said synchronized cardioversion on a walking talking VTach patient would be his first line treatment! If the patient is mentating well and has a decent BP (even if it is slightly lower than you would expect) you first try Amiodarone 150 mg IV over 10 minutes (or longer if you are too afraid of tanking their BP) or IVP Lidocaine. If the patient deteriorates further or the drop their BP further then yes, consider sedation and cardioversion. Syncronized cardioversion is NOT the first line treatment in a STABLE Vtach patient!

#5 Never argue your answer when on an interview, especially on a clinical question that I am assuming you have little to no experience with (and the person interviewing may have tons of experience with). Next time don't guess, just explain to the interviewer you are looking forward to learning this information as you work in the ER and will be attending an ACLS class, as well as doing your own self paced learning.

Don't be too hard on yourself. You are a new grad and that was a more involved question than the average new grad is going to be able to answer! Keep your chin up and start researching emergency related illnesses, so that you are better prepared next time!

Annie

rhkenji · Jan 10, 2016

Thank you for the replies. I learned a lot from this post alone.

I knew how to react in ACLS situation... but due to the nervousness I had, Vtach with a pulse didnt register to me... I assumed it was SVT.

I see your point about the carotid massages. I've seen it during one of my clinicals in a CVICU, I guess it just imprinted on me as "ok thing to do". I guess I'll stick to valsalva manuever using a straw (FOR SVT, Not VTACH) [thanks Annie]

mago8388 · Jan 10, 2016

Don't you cardiovert when it's Vtack that's symptomatic?

rhkenji · Jan 10, 2016

Yes, you do.

AnnieOaklyRN, BSN, RN, EMT-P · Jan 10, 2016

Don't you cardiovert when it's Vtack that's symptomatic?

NO YOU DON'T!! Just because someone is in VTACH AND HAS SYMPTOMS does not mean you automatically cardiovert!! Cardioversion is EXTREMELY painful (even with sedation!) and should be used as a last resort when someone is symptomatic AND UNSTABLE!! By unstable I mean they are not mentating well or are unconscious! Try medications first, and only resort to electricity if the person becomes unstable or the medications are not working over a period of time!

An example of this is a patient I had on the ambulance a few months ago. Sitting on toilet called because he was experiencing palpitations. Put him on monitor, he is in VTach with a thready radial pluse, BUT MENTATING NORMALLY! Extricated from his house, put in ambulance, IVs started,VS obtained (HR 180, BP 88/65, RR 15) ENroute to the hospital 150 mg of IV Amiodarone started with the intent to deliver it over 10-15 minutes. During transport patient became less alert, restless (if you see this in a medical patient or trauma patient it is a sign the brain and body are not getting enough perfusion and they are in some form of shock) , no longer answering most of our questions, Systolic BP down to 70, patient given Versed and cardioverted.

Keep in mind I gave some time for the Versed to kick in (although the patient had poor perfusion, so it would have taken to long for full effect) and he still screamed and remembered the shock! This is a great example because the patient in this case was hypotensive, but again he was talking and mentating completely normally so we did not rush to shock him! Getting shocked, so I have been told, is the equivalent to getting kicked in the chest by a clysdale horse!

If someone is mentating normally, their brain is getting perfused!! Don't give someone a jolt if you don't have to!

Annie

ScrappytheCoco · Jan 10, 2016

If they are asymptomatic we would probably initiate an amiodarone bolus/drip. Unstable we cardiovert. Either would be admittred and possibly scheduled for ICD inseriton...that's up

to cardiology. Pulseless...well hopefully you know what to do for that.