Ventricular Tach -- when to call the doc

[StJohnRiver]

I work nights and invariably patients develops runs of A-Fib, A-Tach, PVCs, etc at 2 a.m. I know anything ventricular is not good, but does a 10-beat run of V-tach that comes out of the blue and is not repeated require an immediate call to the attending or cardiac consult? If it was 20 beats, would that make a difference? Do you have set policies/perameters at your place for tele patients and when to call the physician?

[CoolDork]

If it is new for the patient, I would def. consider calling the provider; however, I would investigate a little more esp. if the pt is non-symptomatic but a run of ten is quite significant. Therefore, I would make sure electrolytes were insignificant, k+, mag...etc, and other check Dx tests completed prior to this event. Then call the MD. It's better to be proactive then reactive.

[VANurse2010]

At my old telemetry job, the policy was 10 beats of more (coincidentally to your situation) then the MD had to be paged and notified. Anything less than that and an immediate page was not required.

[nursekellymarie26]

It is so funny you post this. My patient had a 16 beat run the other night out of the BLUE. BP was in the 130s/60s and was asymptomatic. K and Mag were normal. I called the doctor and they said "order some labs." That was it! I was paranoid the rest of the night. We are always supposed to call for 6 or more VT beats.

[PacoUSA, BSN, RN]

Anything less than 6 beats of VT and is unsustained with no symptoms usually does not warrant calling the doctor, but we always make a note.

[MunoRN, RN]

In general treat the patient's response and their potential response to a rhythm, not the rhythm. The number of beats that require a call to the Doc isn't a set number. Different care settings, different histories, different plans of care, and different established plans of care all make for differences in when a Doc should be called. For post STEMI's out of the cath lab with successful interventions we don't call the doc for any length of VT unless it's refractory to the various ways of dealing with it we're given. In a patient where runs of VT are new, without potential explanations, and without any plan to investigate a cause then that would necessitate a call. In general though, when in doubt, call.

[dah doh, BSN, RN]

What does your policy state? Ours used to be 3 beats in a row with a rate > 150 bpm. It has changed to 30 beats in a row or more with a rate > 150 bpm. We institute a standardized procedure if the patient meets parameter unless there is an order otherwise; then call the doctor to notify that you instituted the standardized procedure.

[kool-aide, RN]

Check k, mag, and phos, assess the pt, especially for respiratory and cardiac status. Our policy is to call for runs of vt greater than 10 but we don't always. The docs don't want to be called unless the pt is symptomatic, has positive Sx of ACS

[canned_bread]

I would check for reasons, but I would not panic unless it was sustained and the patient was unconscious. We sometimes deal with patients who are in VT but CONSCIOUS and stable. The definition of VT as opposed to ectopics is MORE THAN 7. So I would call the on-call ward doctor and state whats occuring, ask what tests they want or if anything special, and go from there.