Our LP12's and fire's Zolls always have this problem, had a firemedic about to push amiodarone on a lady not too long ago, until we reminded him to ask about a pacer, but damn, it looked like VT on the screen until we printed a strip.
V Tach Cardioversion
- Thread starter truetiger
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Our LP12's and fire's Zolls always have this problem, had a firemedic about to push amiodarone on a lady not too long ago, until we reminded him to ask about a pacer, but damn, it looked like VT on the screen until we printed a strip.
Melbourne MICA
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Vt
Late as usual but my two bobs worth.
VT is classified as a lethal arrhythmia therefore calling VT "stable" is a semantic exercise reflecting only VT with a pulse and half decent BP (>100sys) and the premise you have a little time to treat before the pt becomes "unstable" or worse goes into VF and arrests. Yes in rare cases some pts have tolerated VT for prolonged periods.
However the only course of action for EMS is to treat and Ts as expeditiously as possible with perfusion state, specifically BP the criterion which simply delineates drugs or electricity mainly because Amiodarone, the typical drug of choice has many side effects not the least of which is to trash BP hence the need to cardiovert with a low BP. Whether the pt has pain, SOB feels faint or not is largely irrelevent and typically they will have one or more of these in any case - that sort of says something about VT never being "stable" in the first place.
VT can be deadly at any rate (always above 100 and more typically 120-150).
It's just imperative the rhythm is correctly assessed (using Brigadas if you know this approach) or simply wide rapid and regular. VT may or may not show P waves (not likely as a rule). The rule of thumb is to treat as VT even if you think it might be SVT with aberrancy. You really don't want to give either adenosine or calcium channel blockers like verapamil to a VT pt.
Pacemaker history must be ascertained though as others have pointed out breakthrough VT is a not uncommon scenario when the pacemaker cannot overide the VT rate - the pt needs to be treated irrespective of pacemaker if they have VT.
MM
Late as usual but my two bobs worth.
VT is classified as a lethal arrhythmia therefore calling VT "stable" is a semantic exercise reflecting only VT with a pulse and half decent BP (>100sys) and the premise you have a little time to treat before the pt becomes "unstable" or worse goes into VF and arrests. Yes in rare cases some pts have tolerated VT for prolonged periods.
However the only course of action for EMS is to treat and Ts as expeditiously as possible with perfusion state, specifically BP the criterion which simply delineates drugs or electricity mainly because Amiodarone, the typical drug of choice has many side effects not the least of which is to trash BP hence the need to cardiovert with a low BP. Whether the pt has pain, SOB feels faint or not is largely irrelevent and typically they will have one or more of these in any case - that sort of says something about VT never being "stable" in the first place.
VT can be deadly at any rate (always above 100 and more typically 120-150).
It's just imperative the rhythm is correctly assessed (using Brigadas if you know this approach) or simply wide rapid and regular. VT may or may not show P waves (not likely as a rule). The rule of thumb is to treat as VT even if you think it might be SVT with aberrancy. You really don't want to give either adenosine or calcium channel blockers like verapamil to a VT pt.
Pacemaker history must be ascertained though as others have pointed out breakthrough VT is a not uncommon scenario when the pacemaker cannot overide the VT rate - the pt needs to be treated irrespective of pacemaker if they have VT.
MM
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TomB
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I mostly agree but will make two points.
1.) Failure to "rule-in" VT with Brugada's does not "rule-out" VT. That point cannot be overemphasized.
2.) Adenosine is acceptable for hemodynamically stable regular wide complex tachycardia according to the 2010 AHA ECC Guidelines.
Tom
1.) Failure to "rule-in" VT with Brugada's does not "rule-out" VT. That point cannot be overemphasized.
2.) Adenosine is acceptable for hemodynamically stable regular wide complex tachycardia according to the 2010 AHA ECC Guidelines.
Tom
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socalmedic
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not only is adenosine acceptable, it is now the recommended treatment for all wide complex tachycardias.
Melbourne MICA
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Vt
Interesting point boys about adenosine. We don't use it here - it was knocked back for use in our SVT protocol because our medicos were apparently worried about the odd asthmatic who might get a bad reaction. Its pretty standard here to see the hospital docs use amiodarone for the VT with a BP and then electricity if crashing though a lot go stright to cardioversion usually with good results ie reversion with a good perfusion state. I can't say I've ever seen anyone use adenosine in the Ed's for VT - but certainly for SVT's - standard approach. I'll read up some more especially the AHA reference that was cited.
Cheers and thanks
MM
Interesting point boys about adenosine. We don't use it here - it was knocked back for use in our SVT protocol because our medicos were apparently worried about the odd asthmatic who might get a bad reaction. Its pretty standard here to see the hospital docs use amiodarone for the VT with a BP and then electricity if crashing though a lot go stright to cardioversion usually with good results ie reversion with a good perfusion state. I can't say I've ever seen anyone use adenosine in the Ed's for VT - but certainly for SVT's - standard approach. I'll read up some more especially the AHA reference that was cited.
Cheers and thanks
MM
TomB
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It is certainly not recommended for irregular polymorphic wide complex tachycardia.
Bro seriously stop smoking crank it is making you say inappropriate things and embarras yourself
mikie
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Isn't that something new in the 2010 ACLS update?
OP
OP
truetiger
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No more atropine in PEA and asystole.
Chronotropic drug infusions are an alternative to pacing
Adenosine for treatment and diagnosis for regular monomorphic wide-complex tachycardia.
New policy: ROSC, titrate oxygen to SpO2 of at least 94%. Start weaning off oxygen ASAP. Avoid hyperoxia.
Supplemental oxygen is not needed for patients with ACS absent signs of respiratory distress (on a side note, this mirrors what is taught in Harrison's Internal Medicine, Rosen's Emergency Medicine, and Tintinalli's Emergency Medicine).
No more atropine in PEA and asystole.
Chronotropic drug infusions are an alternative to pacing
Adenosine for treatment and diagnosis for regular monomorphic wide-complex tachycardia.
New policy: ROSC, titrate oxygen to SpO2 of at least 94%. Start weaning off oxygen ASAP. Avoid hyperoxia.
Supplemental oxygen is not needed for patients with ACS absent signs of respiratory distress (on a side note, this mirrors what is taught in Harrison's Internal Medicine, Rosen's Emergency Medicine, and Tintinalli's Emergency Medicine).
mikie
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JPINFV
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You know... I thought that looked familiar, especially the part about Harrison's, Rosens, and Tints.
http://connect.jems.com/forum/topics/aha-emergency-cardiac-care
Edit: Note: Not trying to has out a copy or paste... just pointing out who wrote it.
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socalmedic
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absolutely correct. i will edit my post to reflect the correct statement.
"Adenosine is recommended in the initial diagnosis
and treatment of stable, monomorphic, wide-complex tachycardia"-AHA ECC 2010 guidelines.