Question

A 72 year old woman is transported to the ED with a diagnosis of chest pain to rule out myocardial infarction MI. During the initial assessment the nurse notes the cardiac rhythm changes from sinus tachycardia to ventricular tachycardia VT with a pulse. Her vital signs are 84/40, pulse 154 and respirations 30. What is the initial treatment for this patient at this time? What drugs should you anticipate administering to this patient? Why are they indicated? What evidence-based precautions must be taken to promote safety for both the patient and the ACLS team? If this rhythm deteriorates to ventricular fibrillation or VT without a pulse, what steps should you take? Why?

Answer 1

Ventricular tachycardia is abnormal heart rate above 100 beats /minute. VT with a pulse has to be attended immediately in th following way

• Perform a vagal manaeurver
• Monitor oxygen saturation and administer oxygen if saturation is less than 94%
• Administer adenosine 6mg bolus
• In case if the patient conditions doesn't improve then 12 mg along with normal saline flush has to be given
• Monitor ECG for any abnormalities like in case of narrow QRS complex administer beta blocker or calcium channel blocker
• Amiodarone is given in case of other medication regimen fails
• defibrillate the patient with 120 to 200 J using a biphasic defibrillator if lands up in ventricular fibrillation

Answer 2

A patient with pulse in VT has to be done the following immediately

• Follow vagal manoeuvre
• Synchronized cardioversion can be done
• Medication :adenosine 6mg bolus has to be administered immediately without any delay (it blocks the conduction time from AV node and thus returning the normal sinus rhythm)
• A second dose of adenosine 12mg can be administered if there is no improvement
• When there is no improvement further amiodarone can be administered ( this prevents repolariation of the heart by stopping potassium receptors getting in the cells and causing irregular haert beat)
• This can be followed by antiarrythmic or beta blockers

The EBP precautions which has to be followed are

For ACLS team the health-care professionals to be at a safer distance while defibrillating ,causation against NSI

For patient minimise the side effects of the treatment with appropriate care to prevent long term complications

When it detoriate to VT without pulse immediately defibrillate (120 to 200j in biphasic defibrillators ) and continue CPR ,if doesn't settles administer Epinephrine to 1mg every 3rd to 5th minute, followed by amiodarone or lidocaine ,if patient stabilised shift to intense cardiac care unit