Symptomatic vs Unstable..huh?

Nurses General Nursing


Hi fellow nurses,

I've been studying for my ACLS, and although I'm probably overthinking, I was hoping to get clarification on Symptomatic pt vs Unstable pt.

To take bradyarrhytmia as an example:

As I understand it, the pt will have symptoms (ie sob, loc change, potentially chest pain, low bp etc)- so he/she is symptomatic.

But, at what point is he/she considered to be unstable? Wouldn't the above symptoms be considered to make the pt unstable? After all, they are not the norm, right? Don't they point at decreasing perfusion?

Pls help me clarify.

Thanks in advance!

Yes, yes, and yes. I think the difference is symptoms are what the patients feel, whereas other criteria for instability don't necessarily take the patient's perception into account (low bp). But often they go hand in hand.

Specializes in Adult and pediatric emergency and critical care.

Patients can also be unstable without symptoms. I recently had a very athletic patient who went into sustained v-tach with a systolic of 70 who denied any symptoms and we had a full conversation about cardioversion.Patients can also be unstable from sepsis but may not have perceived symptoms, especially if they are suppressed. Many of our PICU kids who are unstable would tell you they feel okay.

Like cleback stated symptomatic is more about what the patient feels and unstable are presentations that are dangerous and require immediate intervention.

This is a question for your ACLS instructor. The patient will be considered symptomatic with chest pain, SOB, palpitations or dizziness.

How low is the BP, is the patient diaphoretic, what is their Glasgow coma scale, and what is the oxygen saturation. The determination of unstable is up to you. Just be ready to administer ACLS.

Welcome to the wonderful world of nursing.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Unstable to me is significant hypotension AND altered mental status or any change in mental status. I never cardiovert unless the patient truly needs it. If they are awake and talking and mentating just fine I will try medications first! Patient's have had PTSD from being cardioverted! Also if they are awake they will need sedation, so if I have to take the time to get that I might as well try an antidysrythmIc first! Adenosine can work wonders for an SVT patient and Amiodarone for Vtach. We also carry Cardizem and Lopressor for afib with a rapid vent. response or atrial flutter wit 2:1 conduction. I have never seen an afib/aflutter patient unstable however, and I would probably look elsewhere if they were hypotensive.


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