Ventricular tachycardia

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Have a quick question for anyone experienced with tele monitoring. I had a patient last night who was normal sinus on the monitor for the whole night. Well, one of my colleagues pointed out to me a strip that printed out of her clearly in the v-tech mode. She showed this to me after, but the patient remained sinus rhythm. Should I have contacted someone or does this happen to some patients?

Specializes in Emergency Nursing.

Um you mean adenosine? Atropine will never slow a patients heart rate down.

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Specializes in ICU, SICU, Burns, ED, Cath lab, and EMS.

12 lead EKGs are helpful to discern what the rhythm is, but you need an order. Some patients with ischemic heart disease or cardiomyopathy are prone to this rhythm. Good to know how they are feeling: any symptoms and what is their blood pressure? Dilitizem is helpful to slow down a narrow complex tachycardia. Amiodarone is commonly used for a fib with RVR and VT. If meds arent enough, AICD are implanted and or VT ablation is done. As previous writers indicated: Mg and K levels are a go place to start.

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12 lead EKGs are helpful to discern what the rhythm is, but you need an order. Some patients with ischemic heart disease or cardiomyopathy are prone to this rhythm. Good to know how they are feeling: any symptoms and what is their blood pressure? Dilitizem is helpful to slow down a narrow complex tachycardia. Amiodarone is commonly used for a fib with RVR and VT. If meds arent enough, AICD are implanted and or VT ablation is done. As previous writers indicated: Mg and K levels are a go place to start.

Is this true?

Back to the OP:

A monitor alarm doesn't mean much.

An actual episode of V-tach may. It is a potentially lethal rhythm. A short episode may proceed a longer, fatal episode.

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Specializes in Emergency, Telemetry, Transplant.
Um you mean adenosine? Atropine will never slow a patients heart rate down.

Oops. Sorry, yes, thanks for the correction…adenosine!

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Specializes in critical care.
Is this true?

Yes, but you'd be hard pressed to find an MD that was bothered by you getting one and putting in the order afterward, especially on a cardiac floor.

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Specializes in Trauma, Orthopedics.
Yes, but you'd be hard pressed to find an MD that was bothered by you getting one and putting in the order afterward, especially on a cardiac floor.

We have standing orders for every patient as part of their admission order set.

I'd be willing to bet the MD would be pissed you called them for the order before doing it, instead of just calling them to let them know you did one/what it looks like/hey I transmitted it for you this looks bad.

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Specializes in 15 years in ICU, 22 years in PACU.
A monitor alarm doesn't mean much.

If the patient was in NSR the entire night except for an isolated monitor alarm that was found long after the event, then do nothing. If it doesn't happen frequently enough to repeat in an eight hour period it's not significant to treat even if it really was VT. If the patient shows absolutely no other clinical signs such as chest pain, nausea or breathing difficulties then the likelihood of artifact is extremely high. A closer look at the monitor alarm strip may reveal the patient was moving around before the alarm triggered. As some have stated look at the whole picture and not just the monitor.

I will have to disagree with some wild attempts to explain your isolated phenomenon. You would never see an isolated episode of A fib with aberrant conduction.

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Specializes in critical care.
We have standing orders for every patient as part of their admission order set.

I'd be willing to bet the MD would be pissed you called them for the order before doing it, instead of just calling them to let them know you did one/what it looks like/hey I transmitted it for you this looks bad.

Agreed! Imagine that conversation....

0400 on the cardiac floor....

RN: operator, would you mind paging cardiology?

10 minutes later.....

RN: hey Dr. Heart, my patient had a 97 beat run of vtach with no pulse, chest pain, diaphoresis, but is NSR now. I was wondering if you think I should get an EKG?

MD: do me a favor. Go get a giant vial of potassium and inject it first into the patient (since you're trying to kill him anyway), and then draw up a second for yourself. Then make the patient NPO and draw some troponins. If you call me with results less than 67, I'll inject you with the potassium myself. (Click)

This is my signature. There are many like it, but this one is mine.

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