VT

Question 1

If the patient is severely compromised

Answer 1

If the patient can obey commands:
a) Gain IV access, administer 1 mg/kg of ketamine IV (up to a maximum of 100 mg) to induce dissociation, and
b) Cardiovert using maximum joules in synchronised mode. Repeat this once if the rhythm fails to revert.
* If the patient cannot obey commands:
a) Cardiovert using maximum joules in synchronised mode. Repeat this once if the rhythm fails to revert, or
b) Attach and use a defibrillator in automatic mode if you cannot use it in manual mode.

Question 2

If the patient is 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

Differentiating VT from SVT with abnormal conduction

Answer 3

VT is most likely if the patient is older, has ischaemic heart disease or is compromised.
* SVT with abnormal conduction is most likely if the patient 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 4

If amiodarone is commenced the full dose should be administered, even if the rhythm reverts to sinus rhythm, unless

Answer 4

severe hypotension or bradycardia occurs.

Question 5

VT secondary to poisoning treatment

Answer 5

The cardiac toxicity may be reduced by a large bolus of sodium ions which is best accomplished using 0.9% sodium chloride:
a) 2-3 litres IV for an adult.
b) 40-60 ml/kg IV for a child.
* If 8.4% sodium bicarbonate is immediately available or can be delivered to the scene within ten minutes, in addition to 0.9% sodium chloride, administer:
a) 100 ml IV over 5-10 minutes for an adult.
b) 2 ml/kg IV over 5-10 minutes for a child.
* Amiodarone should not be administered in this setting because it can be associated with severe worsening of shock without resolution of the rhythm.