I know that the patient is unstable when there is pulseless VT. But Why can't you synchronise pulseless VT and put patient risk at VF or Torsade by R on T?Pulseless doesnt mean that there is no electrical activity like PEA. It just means there is no cardiac output and blood pressure. Does anyone know?
Great question! When the patient is in VT with a pulse (aka stable VT) they are still producing a cardiac output and BP. Time is of the essence in cardioverting them back into a normal rhythm because they are most likely going to become unstable (lose their pulse) in a short period of time. Cardioversion is used to avoid shocking them at the wrong point of the cardiac cycle and put them into VFib. When they lose their pulse in VT, they are considered unstable and the QRS, R and T waves do not correspond to a cardiac output and BP. Therefore, it does not matter at what point of the cardiac cycle the patient is shocked (in this case, defibrillated). Another major difference is that the joules used for cardioversion are less than the ones used for defibrillation. Yes, the pt may end up in VFib, but the tx for pulseless VT and VFib is the same. Additionally, according to ACLS guidelines, the patient will receive medications (Epinephrine and antiarrhythmics like Amiodarone or Lidocaine) to try and stabilize the tachyarrhythmia in conjunction with defibrillation. Check out my video about VT: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-mWamxIXNhJs.html This article may also help to clear things up: acls-algorithms.com/rhythms/pulseless-ventricular-tachycardia/ (click on Cardiac Arrest Diagram) Hope this helps!
Hi Aya, thank you for your comment. In Vfib, the patient will be pulseless and apneic and therefore only defibrillation is indicated. I have updated the audio and video description to reflect this.
