3.8: Ventricular Tachycardia

Question 1

VT Criteria and Initial actions

Answer 1

• Adult
• Sustained VT, or undifferentiated broad complex tachy,
• Rate > 150 AND not in cardiac arrest
• Attach defibrillation pads.
• Acquire a 12 lead ECG whenever feasible.
• Do not administer GTN, even if the patient has cardiac chest pain.
• Determine the level of cardiovascular compromise

Question 2

Patient not severely compromised

Answer 2

• Gain IV access and administer 300 mg of amiodarone IV over approximately
30 minutes.
• Administer a further 150 mg of amiodarone IV over approximately
30 minutes if the patient remains in VT.
• Administer amiodarone with caution if the patient is poorly perfused and reduce the rate of administration if there is a significant fall in blood pressure
or cardiac output.

Question 3

Severe Compromise, Obeying commands

Answer 3

• 1mg/kg Ketamine (Max 10mg)
• Sync Cardiovert at max jules (Cardioversion checklist)
• Repeat x 1 if fails to revert
• Seek clinical advice if cardioversion fails

Question 4

Severe Compromise, Not Obeying commands

Answer 4

Able to Sync Cardiovert?
No -> Attach in AED mode
Yes – >
- Sync Cardiovert at max jules (Cardioversion checklist)
- Repeat x 1 if fails to revert
- Seek clinical advice if cardioversion fails

Question 5

Backup

Answer 5

R50 for all patients, even if spontaneous reversion

Nil R50 available? R51 or PRIME

Question 6

General Principles

Answer 6

Broad complex if QRS >0.12
Ventricular rate usually >150
VT usually associated with compromise
Broad complex tachy + compromise should be assumed
to be VT and treated accordingly

Question 7

VT is most likely if the patient:

Answer 7

• Is older,
• Has ischaemic heart disease
• Is compromised.

Question 8

SVT with abberancy is most likely if the patient:

Answer 8

• Is younger,
• Does not have ischaemic heart disease, or
• Is not compromised.
  Successful previous
  treatment with adenosine is indicative of a history of SVT.

Question 9

Precordial concordance (where the QRS complexes in leads V1-6 are alleither negative or positive) is more likely in?

Answer 9

VT

Question 10

Right axis deviation is more likely in?

Answer 10

VT

Question 11

Capture beats (narrow QRS complexes occurring within a run of broad complex tachycardia) indicate atrioventricular dissociation and are more
likely with?

Answer 11

VT

Question 12

Fusion beats (when a normal and a wide complex QRS join to form a hybrid QRS complex within a run of broad complex tachycardia) indicate
atrioventricular dissociation and are more likely with?

Answer 12

VT

Question 13

VT can be secondary to poisoning with?

Answer 13

Cyclic antidepressants (triptyline)

Question 14

Treatment for cyclic poisoning?

Answer 14

• 2-3 litres of 0.9% sodium chloride
• 8.4% sodium bicarb IF deliverable within 10 minutes
  
  • Administer 100ml over 5-10 mins in addition to NaCl
    Withhold amiodarone - worsening shock, nil resolution of rhythm