Pulseless torsades

[VFlutter]

Now for all the talk on Torsades, do I sync, d-fib? the story doesn't lie. Medical director gave kudos! This treatment would have been different of course with a stable pt...but this would be a typical ACLS algorythm.

I do not think anyone is arguing what to do with Pulseless TDP. The grey area is the truly unstable patient who, for the moment, still has a pulse.

 

[SandpitMedic]

Defib Torsades... Immediately upon recognition of unstable pt. Always. No sync involved.

Stable/grey area. Mag 2g in 50NS over 10 minutes. If refractory, defib.

Any pulses felt with TDP are coincidental, as it is not organized activity of the heart. If blood should be ejected in a manner to sustain life it's a miracle. Let alone for 10 minutes, per our protocol.

It is a lethal dysrhythmia. And it must be stopped.

 

[NomadicMedic]

I've only seen Torsades twice. It was self limiting both times. The first was a stable patient and it converted back to a sinus brady spontaneously. That patient never had another run of it and the doc didn't believe me until I showed him the strip. The other occurrence was a patient who quickly degraded to VF. A defib converted that patient. To asystole. Where they stayed.

In the prehospital world, you've really only got two options. Mag and electricity. Three if you count "wait and see what happens".