03.09 Ventricular Tachycardia (V-tach)

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Overview

  1. Ventricular Tachycardia
    1. Multiple unorganized electrical signals in the ventricles
      1. Ventricles contract at a rate of 150-250 bpm
      2. May or may not have pulse
      3. Significantly reduces CO and perfusion

Nursing Points

General

  1. Characteristics of Ventricular tachycardia
    1. Rhythm
      1. Regular
      2. Irregular
    2. Rate
      1. 150-250 bpm
        1. Ventricular rate
    3. P:QRS ratio
      1. No  P waves
        1. Not measurable
    4. PR interval
      1. No P waves
        1. Not measurable
    5. QRS complex
      1. > 0.12 seconds  
      2. “Wide”

Assessment

  1. Patient Presentation
    1. Palpitations
    2. Chest pain
    3. Decreased CO
      1. Hypotensive
      2. LOC changes
      3. Lightheaded
      4. Syncope
  2. Pulse or pulseless
  3. Electrolytes

Therapeutic Management

  1. Nursing Interventions
    1. Determine if a pulse is present
    2. Sustained or Unsustained
      1. Monomorphic
      2. Polymorphic
  2. Determine/Treat the cause
    1. Electrolytes
    2. MI
    3. Abnormal heart conditions
  3. Follow ACLS guidelines
    1. V-tach with pulse
      1. Amiodarone IV
      2. Magnesium Sulfate IV
      3. Synchronized Cardioversion (CV)
    2. Pulseless V-tach
      1. CPR
      2. Defibrillate
      3. Epinephrine

Nursing Concepts

  1. EKG Rhythms
  2. Perfusion

Patient Education

  1. Seek medical help

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Video Transcript

Hey guys, so in this lesson we are going to talk about ventricular tachycardia, also called V-tach. We are going to break down the characteristics of it on an EKG and talk about nursing interventions and treatments for V-tach. It is a pretty important rhythm to recognize because people can die quickly if we don’t do something about it. So let’s get started!

So in Ventricular Tachycardia there are multiple unorganized electrical signals in the ventricles, this causes the ventricles to contract at a rate of 150-250 beats per minute. Because the ventricles do not slow down enough to fill back up with blood, cardiac output is significantly decreased. Because of that, a person who is in V-tach may or may not have a pulse so it is imperative to assess that when you see this rhythm.

So let’s use the 6-step method and break down the characteristics of V-tach. So in step 1 we need to determine if the rhythm is regular or irregular, so if need to try to find the number of boxes in between the R waves so we will try from here to here and we have about 11-12 and here to here 10-11 and here to here 12. So our rhythm is regular with V-tach it will be regular or irregular. in step 2 let’s count the heart rate, we multiply 13 by 10 and get 130. But let’s also do the 1500 method for a more accurate rate, so 1500 divided by 11 and we get 136 beats per minute. In step 3 we need to look at the P:QRS ratio, and that is not measurable since we do not have P waves. In step 4 we look at the PR Interval and again it is not measurable since we do not have P waves. In step 5 we look at the QRS complex so if we measure from here to here we have 11 small boxes or 0.44 seconds. So in step 6 we identify our rhythm and it is ventricular tachycardia. Let’s recap the characteristics, the rhythm can be regular or irregular, the rate is between 150-250 beats per minute for the most part. The P:QRS ratio and PR interval is not measurable since there are no P waves. The QRS complex is wide. This is one of those rhythms that when you see it you don’t not stop and count anything or go through the steps, you should recognize it right away and go check on your patient! This is not one of those rhythms you need to analyze, this is one of those rhythms that make you jump! People can go into cardiac arrest and die if we don’t do anything about this rhythm. So now let’s talk about managing V-tach.

So most patients that come in with Ventricular tachycardia will have palpitations, chest pain and because of the decreased cardiac output, they will be hypotensive, with altered level of consciousness, they will also be lightheaded have syncope. The priority nursing interventions are to find out if they have a pulse or not the second you see this rhythm. People with v-tach can or cannot have a pulse, it depends on the severity of the cardiac output. Find out if it is sustained or unsustained, if there is a patient in a normal sinus rhythm and all of a sudden they have a run of v-tach and go back to normal sinus rhythm, we call this unsustained and it is just a run of vtach. If it is sustained, it’s not going away. You also need to find out if it is monomorphic v-tach or polymorphic v-tach. Basically if all of the QRS look the same it is monomorphic if they look different it’s polymorphic like in this strip here. This would be called polymorphic ventricular tachycardia.

So therapeutic management for ventricular tachycardia is to determine the cause and treat it, it may be something so simple as an electrolyte abnormality or an MI. We also need to follow the ACLS guidelines for V-tach. So once you determine if the patient has a pulse then we treat it with Amiodarone 150 mg IV or 1 or 2 grams of Mag Sulfate. We can also do a synchronized cardioversion if the meds do not work and the V-tach persists. Now if they are unstable and do not have a pulse, we treat that differently. They don’t have a pulse so there is no cardiac output, they are going to die! So we need to start CPR immediately and defibrillate them and give epinephrine according to the ACLS guidelines. A quick note, when you hear synchronized or unsynchronized cardioversion, basically when the defibrillator machine is set to synchronize it synch with the R waves to deliver a low voltage shock after repolarization. When you hear unsynchronized it is the same as defibrillate and it means a higher voltage shock is delivered as soon as the button is pushed. Make sure no one is touching the patient!

So the key points to take a way from this lesson are to remember the abnormalities of ventricular tachycardia. The ventricles are rapidly contracting at a rate of 150-250 beats per minute. People may or may not have a pulse with V-tach. So the priority nursing intervention is to assess the patient first and see if there is a pulse present. Then follow the ACLS guidelines, so if there is a pulse we try medications first then a cardioversion, if there is not a pulse we need to do CPR and defibrillate them and give them meds to save their life.

I hope that you guys have enjoyed this lesson and feel more comfortable identifying ventricular tachycardia and know what interventions to implement. Make sure you check out all of the resources attached to this lesson. Now, go out and be your best self today! And, as always, happy nursing!

Read more

  • Question 1 of 8

The nurse prepares the client for defibrillation due to sustained and pulseless ventricular tachycardia. Which of the following measures should the nurse ensure before delivering the shock?

  • Question 2 of 8

During insertion of a pulmonary artery catheter, the nurse watches the patient’s cardiac monitor for changes in the waveform. As the nurse is assisting the provider with obtaining a wedge pressure, the nurse notes that the procedure has caused ventricular tachycardia. What the is the appropriate response?

  • Question 3 of 8

The nurse is caring for a telemetry client. Upon entering the room, the nurse notices a few premature ventricular contractions on the cardiac monitor. As the nurse begins an assessment, the client goes into ventricular tachycardia on the monitor. Which of the following nursing actions is most appropriate?

  • Question 4 of 8

The nurse places a client on the cardiac monitor and observes the heart rhythm. Which rhythm requires the most urgent intervention?

  • Question 5 of 8

A nurse observes this rhythm on telemetry monitor, which of the following is the first action the nurse must implement?

  • Question 6 of 8

The nurse is caring for a telemetry client whose EKG (ECG) results are available. The nurse recognizes which rhythm as an emergency?

  • Question 7 of 8

A student nurse is explaining ventricular tachycardia to a group of students. The nurse is correct in stating which of the following?

  • Question 8 of 8

A nurse is caring for a client in the ICU who has a history of cardiac dysrhythmias. The client goes into a state of ventricular tachycardia and the nurse is unable to find a pulse. The code team arrives and delivers a shock of defibrillation to the client at 360 Joules. Which step would the nurse perform next?