Pulseless ventricular tachycardia is a life-threatening cardiac arrhythmia in which coordinated ventricular contractions are replaced by very rapid but ineffective contractions, leading to insufficient organ perfusion and heart failure. Pulseless ventricular tachycardia is a medical emergency.
Identify:
Heart Rate: heart rate greater than 100/min
Rhythm: Wide Complex Ventricular Tachycardia (Monomorphic Tachycardia)
P wave:none present
QRS Complex: Wide greater than 0.14 seconds;
ST segment: none present
Patient is Considered Unstable
- Level of Consciousness (unresponsive)
- Hypotension (Systolic Less than 90mmHg.)
- Chest Discomfort or Shortness of Breath
- Saturation: less than 92%
- HR greater than 100/min
Initial Considerations:
- Consider Oxygenation
- Monitor and Continue Observing
- Obtain IV/IO Access
- Attempt the Vagal - Include Outside link for Vagal Manuever
- Adenosine (Antiarrythmic)
- 1st dose: 6mg
- 2nd dose: 12mg
Treat as Unstable
- Shock: Biphasic (120-200J) Monophasic 360J
- CPR (2min)
- Drugs
- Epi 1mg.
- Amiodarone 300mg or Lidocaine 1 - 1.5mg/kg
- Amiodarone 150mg or Lidocaine .5-.75mg/kg
Causes:
- Structural heart disease
- coronary artery disease
- aortic stenosis
- cardiomyopathy
- congenital heart failure
- hypertrophic obstructive cardiomyopathy
- myocardial infarction
- Electrolyte Disturbances
- Hypokalemia
- Hyperkalemia
- Hypomagnesium
- Hypocalcemia
- Drugs/medications
- Congenital
- The most common cause of pulseless ventricular tachycardia is cardiac ischemia