I was in a touchy situation recently, and took on a patient who was in vtach to my eye with diaphoresis and sob. The docs chose to wait for labs before treating the heart rhythm, and with one thing and another there were no new orders until 2h later when the IM consult arrived. (Yes I advocated for my patient, I am the loud mouth of my unit, but I was unsuccessful).
I've never heard of a wide complex tachycardia being anything but vtach, but I was told it is aberrant conduction, not ventricular. Should it not be treated as a vtach, if s/he is symptomatic? We were needing 100%o2 to keep sats above 90%. I'll enclose the IM comment on the rhythm. The patient converted to an afib at about 2200.
"ECG at 1945 queries limb lead reversal. The rhythm suggests atrial
fibrillation with a rate of 150 beats per minute. There is aberrant
conduction with QRS increased at 146 milliseconds with a large voltage in the
precordial leads. Repeat tracing at 2215 showed atrial fibrillation at 139
beats per minute with a QRS narrowed to 106 milliseconds. There is evidence
of a prior anterolateral infarct. Corrected QT interval is now within normal
limits."
I'm looking to educate myself on this, so if anyone can point me to reading material, that would be great.
canoehead, BSN, RN
6,909 Posts
tegridy, He needed it to maintain his sats. bt with a sustained hr >150 I would give it to him just to decrease the workload.