Megacode: Unstable Ventricular Tachycardia Part 5

After placing the monitor/defibrillator back into the synch mode, the joule settings on the above patient are increased and a synchronized shock is delivered.  The unstable ventricular tachycardia is converted to a sinus rhythm.  Blood pressure: 98/64.  Heart rate: 75.  Respiratory rate: 16. Oxygen saturation: 97% on 2L/min via nasal cannula. The patient remains sedate from the versed and fentanyl.  IV fluids are infusing at 150ml/hr.   At this point, the MD wants to start the patient on an antiarrhythmic to further suppress any recurring ventricular rhythm. But he first want to evaluate another EKG.

Cardioversion of ventricular tachycardia

21.  16. Name three antiarrhythmics that can be used to treat stable VT?

a.       

b.      

c.      

22. What is the initial dosage of Lidocaine used in the treatment of wide complex tachycardia?

a.       Lidocaine 1-1.5 mg/kg IV push

b.      Lidocaine 150mg IV over 10 minutes

c.       Lidocaine 0.25-0.35mg/kg IV over 5 minutes

d.      Lidocaine 2-2.5mg IV over 5 minutes

23.  Match the following medications with their correct corresponding dosages.

a. 1st dose of Amiodarone                         0.5-0.75mg/kg

b. 2rd dose of Lidocaine                            12mg                    

c. 3st dose of Adenosine                            20-50mg/kg                       

d. Initial dose of Procainamide                   150mg IV infusion

24.  What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse?

a.       

b.      

c.       

d.      

25.  After delivering a synchronized shock to a patient you notice that the patient’s heart rhythm changes to VF.  What would you do?

Answers

21.  16. Name three antiarrhythmics that can be used to treat stable VT?

a.       Procainamide

b.      Amiodarone

c.       Lidocaine

22. What is the initial dosage of Lidocaine used in the treatment of wide complex tachycardia?

a.       Lidocaine 1-1.5 mg/kg IV push

23.  Match the following medications with their correct corresponding dosages.

a. 1st dose of Amiodarone         150mg IV infusion

b. 2rd dose of Lidocaine            0.5-0.75mg/kg

c. 3st dose of Adenosine            12mg

d. Initial dose of Procainamide    20-50mg/kg

24.  What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse?

a.       The patient receives the maximum dose of 17mg/kg

b.      The rhythm is suppressed

c.       The patient becomes hypotensive

d.      The QRS complex widens over 50% from baseline.

25.  After delivering a synchronized shock to a patient you notice that the patient’s heart rhythm changes to VF.  What would you do?

If the patient develops VF then deliver an unsynchronized high energy shock at 200 J and follow the pulseless VF/VT algorithm.