Pulseless torsades

[xrsm002]

I am asking this question because I'm a little confused. I swear I was told in class that PEA is any rhythm without a pulse (I may have misunderstood my instructor at the time). My question is if someone is in torsades and are pulseless and apneic wouldn't that be pea? Someone told me no. I'm confused. Can someone please clarify. I searched on here but couldn't find anything in this.

 

[DesertMedic66]

It's still PEA. It's a polymorphic ventricular tachycardia.

 

[xrsm002]

It's still PEA. It's a polymorphic ventricular tachycardia.

Thank you I had a paramedic tell me it wasn't PEA.

 

[NomadicMedic]

While it's technically a PEA, it would be classified as "pulseless Vtach" and treated as such. We generally differentiate between pulseless rhythms simply to define treatment algorithms. Shockable vs. not shockable.

Think of PEA as a rhythm that LOOKS like it should have a pulse, but doesn't.

With a pulse, sinus brady. With NO pulse, it's PEA.

 

[DesertMedic66]

While it's technically a PEA, it would be classified as "pulseless Vtach" and treated as such. We generally differentiate between pulseless rhythms simply to define treatment algorithms. Shockable vs. not shockable.

Think of PEA as a rhythm that LOOKS like it should have a pulse, but doesn't.

With a pulse, sinus brady. With NO pulse, it's PEA.

That's a better explanation

 

[281mustang]

While it's technically a PEA, it would be classified as "pulseless Vtach" and treated as such. We generally differentiate between pulseless rhythms simply to define treatment algorithms. Shockable vs. not shockable.

Think of PEA as a rhythm that LOOKS like it should have a pulse, but doesn't.

With a pulse, sinus brady. With NO pulse, it's PEA.

Albeit the treatment for torsades falls under the v-fib/pulseless v-tach algorithm I wouldn't necessarily say it's treated EXACTLY the same as mag sulfate still needs to be incorporated.

 

[xrsm002]

Do for NR testing purposes (if I was to get this arrhythmia) I would tell them it's torsades but I'd treat at pulseless Vtach?

 

[xrsm002]

I get confused because I had a patient during clinicals c/c fluttering in chest hook up to monitor and it showed NSR then about every 3-5 minutes she would go into Torsades then back to NSR it was crazy.

 

[VFlutter]

I get confused because I had a patient during clinicals c/c fluttering in chest hook up to monitor and it showed NSR then about every 3-5 minutes she would go into Torsades then back to NSR it was crazy.

Torsades, or Polymorphic VT, may or may not cause pulselessness much like monomorphic VT. People commonly have non sustained torsades. Sustained torsades will eventually become pulseless do to lack of adequate ventricular filling just like most sustained VT. I would not classify Torsades as PEA because it commonly presents without a pulse.

On a side note, Torsades is classified as polymorphic VT in the setting of prolonged QT. You can have PVT which is not by definition Torsades.

 

[Handsome Robb]

I've never seen TDP with a pulse. Only pulseless.

Here's a question for you...TDP with a pulse, what do you do? Symptomatic.

 

[DesertMedic66]

I've never seen TDP with a pulse. Only pulseless.

Here's a question for you...TDP with a pulse, what do you do? Symptomatic.

How symptomatic?

 

[xrsm002]

How symptomatic?

1-2g magnesium sulfate. My particular patient was stable with the exception of her chest fluttering sensation.

 

[Handsome Robb]

How symptomatic?

I didn't ask you, :censored::censored::censored::censored::censored::censored::censored::censored:!

I'll give you two options, same PT. 70 yo M with palpitations. Cardiac hx and HTN, no allergies, standard post MI and HTN meds.

1) BP 70/24 a&ox1 GCS 13.

2) 110/70 a&ox4 GCS 15.

Sorry, on my phone so it's short and sweet.

 

[Akulahawk]

While TDP can be considered a PEA, it must be looked at in the same light as any VT... which can also be PEA, but they're classified differently because they're treated differently. The reason I say that TDP and VT could be considered a PEA is because it (especially if the rate is slow enough) can present quite easily with a pulse (and be relatively stable at that). I've seen monomorphic VT that was quite stable for a good 2-3 hours...

 

[Bearamedic]

Tdp is a polymorphic ventricular tachycardia.

We can have pulseless tdp and tdp with a pulse.
We have can have pulseless vtach and vtach with a pulse.

Would most people label pulseless vtach as a pea?


I think it is probably semantics, dependent on whether most people think that tdp looks like it should have a pulse.


imo, tdp is independent of pea. i would check for (no) pulse before i start chest compressions.

 

[teedubbyaw]

I didn't ask you, :censored::censored::censored::censored::censored::censored::censored::censored:!

I'll give you two options, same PT. 70 yo M with palpitations. Cardiac hx and HTN, no allergies, standard post MI and HTN meds.

1) BP 70/24 a&ox1 GCS 13.

2) 110/70 a&ox4 GCS 15.

Sorry, on my phone so it's short and sweet.

1) defib, mag drip
2) mag drip

 

[chaz90]

1) defib, mag drip
2) mag drip

Okay, but let's switch defib to sync cardiovert. It's those darn technicalities that get you

 

[teedubbyaw]

Okay, but let's switch defib to sync cardiovert. It's those darn technicalities that get you

In torsades/poly Vtach? Lol

 

[DesertMedic66]

Redacted

 

[chaz90]

In torsades/poly Vtach? Lol

It should still sync up...