Ventricular Tachycardia with a Pulse
Scenario: Mr. Jones is a 50y/o male that presents to the emergency department
with fluttering sensation to the chest, increased anxiety, lightheadedness, and
nausea. The patient is pale and diaphoretic upon assessment.
Student takes over and calls for full set of vitals, o2, IV access, & cardiac monitor.
Vital Signs: BP 80/60, HR 175bpm, RR 21, o2 89% on room air, T 99.0
Rhythm displayed on monitor:
Student verbalizes rhythm is Ventricular Tachycardia with a pulse & identifies
need to intervene because the patient is symptomatic (hypotensive, chest
discomfort, altered mental status)
Interventions:
Prepare for synchronized cardioversion (demonstrate putting monitor into
sync mode)
Medication administration: Adenosine 6mg RAPID IV push followed by
rapid normal saline flush
Sync monitor, dial energy 50-100 J (narrow complex), 100 J (wide
complex), clear patient, charge, administer energy
Have patient attempt vagal maneuvers
Provide analgesia for procedure if available
Administer second dose of Adenosine 12mg RAPID IV push followed by
rapid normal saline flush
Administer 2nd synchronized cardioversion 100 J
Be prepared for patient to possibly have a rhythm change into ventricular
fibrillation, losing pulse, & becoming unresponsive.
Discuss importance of type of energy delivered, patient stable vs unstable, &
symptomatic.
