Ventricular Tachycardia, Pulseless, Unstable, Stable?

[spenac]

Pulseless ventricular tachycardia, unstable ventricular tachycardia, and stable ventricular tachycardia. Whats the difference? How do you treat them differently?

Here was a decent discussion. Read and discuss more. Thats an order.

http://emedicine.medscape.com/article/7609...yDepartmentCare

[web:9f1e9c0c2d]http://emedicine.medscape.com/article/760963-treatment#TreatmentEmergencyDepartmentCare[/web:9f1e9c0c2d]

[CTXMEDIC]

we treat just as posted. not sure what you wanna discuss.

[AnthonyM83]

"Unstable VT

* Unstable VT is characterized by signs/symptoms of insufficient oxygen delivery to vital organs such as chest pain, dyspnea, hypotension, or altered level of consciousness, indicating that rate and stroke volume are not providing adequate cardiac output.

* In this situation, the dysrhythmia should be immediately treated with synchronized cardioversion, usually at a starting energy dose of 100 J.

* In contrast, polymorphic VT is treated with immediate defibrillation as the defibrillator may have difficulty recognizing the varying QRS complexes and thus synchronizing the delivery of energy."

As someone who hasn't taken ACLS, it seems this is telling that if a polymorphic VT patient is unstable with a symptom like chest pain, but still awake, I should defibrillate him????? It clearly made a contrast with cardioversion, so it doesn't seem like they mean cardioverting.

I thought you never defibrillated a conscious patient...

[Kiwiology]

Puseless VT = cardiac arrest, quick, get the deflubberlator!

Unstable VT = VT causing physiological abnormalities (shock, CCP, ALOC etc)

Stable VT = VT with no abnormal V/S or altered haemodynamics

[AnthonyM83]

Not sure what that means Kiwi...it seemed to echo the VT classifications, but I wanted to specifically make sure defibrillating a fully conscious patient is appropriate.

I've been told the signs of unstable VT before, but was told not to defibrillate (rather than cardiovert) if alert (but with chest pain).

(Not sure what CCP is...)

Thanks for the help.

[scott33]

Central chest pain

[spenac]

"Unstable VT

* Unstable VT is characterized by signs/symptoms of insufficient oxygen delivery to vital organs such as chest pain, dyspnea, hypotension, or altered level of consciousness, indicating that rate and stroke volume are not providing adequate cardiac output.

* In this situation, the dysrhythmia should be immediately treated with synchronized cardioversion, usually at a starting energy dose of 100 J.

* In contrast, polymorphic VT is treated with immediate defibrillation as the defibrillator may have difficulty recognizing the varying QRS complexes and thus synchronizing the delivery of energy."

As someone who hasn't taken ACLS, it seems this is telling that if a polymorphic VT patient is unstable with a symptom like chest pain, but still awake, I should defibrillate him????? It clearly made a contrast with cardioversion, so it doesn't seem like they mean cardioverting.

I thought you never defibrillated a conscious patient...

If unable to sync you shock, hoping to reset. It is prefered if able to do syncronized cardioversion, shock that coincides with what the heart is doing. You can also try chemical cardioversion. A point if they are alert sedate if time allows because it hurts per patients telling me. Hope I made sense.

[Arizonaffcep]

* In contrast, polymorphic VT is treated with immediate defibrillation as the defibrillator may have difficulty recognizing the varying QRS complexes and thus synchronizing the delivery of energy."

As someone who hasn't taken ACLS, it seems this is telling that if a polymorphic VT patient is unstable with a symptom like chest pain, but still awake, I should defibrillate him?????

Polymorphic VT is also known as Torsades de Pointes for which the preferred treatment is 1-2g of Magnesium over 5-60 min.*, followed by a drip.

Page 11 of the 2005 Guidlelines ECC "Handbook of Emergency Cardiovascular Care"

[mobey]

"Unstable VT

* In contrast, polymorphic VT is treated with immediate defibrillation as the defibrillator may have difficulty recognizing the varying QRS complexes and thus synchronizing the delivery of energy."

As someone who hasn't taken ACLS, it seems this is telling that if a polymorphic VT patient is unstable with a symptom like chest pain, but still awake, I should defibrillate him????? It clearly made a contrast with cardioversion, so it doesn't seem like they mean cardioverting.

I thought you never defibrillated a conscious patient...

Ya Anthony, polymorphic VT is a lethal rhythm. It is inpossible to sync and cardiovert because you cannot capture it. Like trying to sync v-fib!

So.... you have to do something, if you think time permits based on pt presentation sedate and defib. If time does not permit tell them it's gonna hurt but is necissary!

I am with Arizona though, Mag is the way to go.

[celticcare]

CCU RN here and yeah, we treat like the site says, assess the heamodynamics, if conscious and tolerating then go down the chemical lines, if unconscious and able to sync, then sync, if unconscious and pulseless then get the lunchbox of life and zap the crap out of them.

Polymorphic *TDP* is Magnesiums best buddy and those two will get along swimmingly , go down that path before electrical therapy. But yes Anthony you are correct, it is a play on words as such. Sedate and defibrillate. Hey that rhymes. But only if the chemical cardioversion hasnt worked or other measures.

Scotty