Trouble With Understanding VT scenario

[mlbdestined]

Is ventricular tachycardia WITH A PULSE shockable? I understand that V-fib and pulseless V-tach are shockable, and that PEA and asystole are not shockable, but I am reading this book on cardiac arrest and it doesn't mention any scenario with v-tach with a pulse. Thank you for any information you can give.

[kathy313]

Do you mean cardioversion?

[emtb2rn, BSN, RN, EMT-B]

I believe you're talking about svt's. Not shockable in the same sense as a pulseless ryhthm.

svt (supraventricular tachycardia) can be managed by vasovagal manuevers, adenosine or cardioversion. Generally in that order.

We once had a svt break while a femoral line was being placed. Cool stuff.

Hope this helps.

[cardiacmadeline, RN]

Per ACLS guidelines--V-tach is a regular wide complex. If the pt is in V-tach and has a pulse, but they are unstable, you need to cardiovert. If they are stable, try amiodarone while preparing for cardioversion. I am not sure what the previous post means, V-tach and SVT are two different arrhythmias treated differently.

[streptococcus]

Yes, both forms of ventricular tachycardia are shockable.

For the unconscious patient you defibrillate

For the conscious patient, you use synchronized cardioversion

For unconscious defibrillation, you shock randomly

For conscious synchronized cardioversion, you switch the cardiac monitor to its synchronized mode and it analyzes the patient’s rhythm and delivers a shock right after the R wave of the heart’s cardiac cycle. The monitor does this to reduce the chance of turning the ventricular tachycardia into ventricular fibrillation.

Ventricular tachycardia can occur while the patient is alert or unconscious, and much depends on the patient’s ability to tolerate the rapid ventricular rate. Some healthier patients can tolerate the increased rate of ventricular contractions and remain conscious, while others with multiple medical conditions may not be able to tolerate the fast rate and become unconscious due to lack of cerebral perfusion.

If the patient is unconscious with ventricular tachycardia, you should defibrillate with 200 jules immediately in an attempt to reset the myocardium’s electrical circuit to a slower rate.

If the patient is conscious and stable, then consider providing oxygen, starting an IV, and administering Amiodarone or lidocaine.

If the patient is conscious and unstable, then you give oxygen, start an IV and administer Diazepam to sedation the patient prior to shocking using the monitor’s Synchronized cardioversion setting.

[emtb2rn, BSN, RN, EMT-B]

Per ACLS guidelines--V-tach is a regular wide complex. If the pt is in V-tach and has a pulse, but they are unstable, you need to cardiovert. If they are stable, try amiodarone while preparing for cardioversion. I am not sure what the previous post means, V-tach and SVT are two different arrhythmias treated differently.

OP doesn't actually state wide or narrow complex, stable or unstable. I "thought" the op might be referencing svt, so that's the answer I gave. You "thought" different.

[Rabid Response]

emtb2rn--The OP did not have to state whether the V-tach was narrow complex or wide complex. V-tach is BY DEFINITION wide complex. The width of the QRS complex is what lets you know the impulses are originating in the ventricles.

[emtb2rn, BSN, RN, EMT-B]

K. I agree. Disregard my misdirection.