Ventricular Tachycardia

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Essential Information

     Since v-tach with a pulse can suddenly become pulseless v-tach, all EMS providers need to be able to look at the patient - not the cardiac monitor - to determine if the patient is stable or unstable. Use this lesson plan to facilitate a classroom training session for your service about the v-tach with pulses article (Stable or Unstable). Before your classroom training and practice session, ask members to read the article and come to the classroom with questions. (Remember, you can make and distribute copies of the article for education purposes.)

Time Needed: 1 to 2 hours

Classroom Training Objectives

• Discuss causes of ventricular tachycardia with pulses.
• Explain differences between stable and unstable ventricular tachycardia with pulses.
• Explain important ventricular tachycardia with pulses findings.
• Review and practice interventions for ventricular tachycardia with pulses.

Group Training Outline

1. Introduce training topic - ventricular tachycardia with pulses - and review important definitions.
   1. Ventricular tachycardia
   2. Hemodynamic stability
   3. Myocardial ischemia
   Teaching Tip: Ask members to define these terms in their own words.
    
2. Discuss these causes of v-tach with pulses:
   1. Aortic stenosis
   2. Heart failure
   3. Structural deterioration of the heart
   4. Congenital heart disorders
   5. Myocarditis
   6. Cardiomyopathy
   7. Electrolyte imbalances
   
    
3. Ask the class to specifically describe how each of these signs of instability would look or sound if a patient was experiencing:
   1. Altered mental status
   2. Loss of consciousness
   3. Shock
   4. Hypotension
   5. Pulmonary edema
   6. Worsening chest pain
   7. Respiratory distress
   
    
4. Apply patient assessment concepts to determining patient stability.
   1. Chief complaint
   2. History of present illness
   3. SAMPLE
   4. Associated signs and pertinent negatives
   Teaching Tip: Ask members to provide associated signs and pertinent negatives that would support conclusion of stable or unstable.
    
5. Use a provider or manikin to demonstrate the locations on the body pertinent to physical exam findings (JVD, diaphoresis, hypoxemia, peripheral cyanosis, rales) associated with v-tach with a pulse.
    
6. ALS provider rhythm analysis - discuss relative criteria for v-tach.
   Teaching Tip: Discuss and review v-tach rhythm strips. Also review rhythms that may be confused with v-tach.
    
7. Discuss assessment techniques for:
   1. Difficult to palpate radial pulse
   2. Difficult to auscultate blood pressure
   3. Physical exam of medical patients
   
    
8. Discuss and explain interventions for VT with pulses. Encourage members to supply specific explanations of how each intervention is applied based on your local protocols.
   1. All providers:
      1. Patient reassurance
      2. Position of comfort
      3. Supplemental oxygen
      4. Monitor SpO2
      5. Monitor vital signs
   2. ALS providers:
      1. IV access for fluids and medications
      2. 12-lead ECG rhythm confirmation
      3. Medication administration
      4. Synchronized cardioversion
   Teaching Tip: Discuss interventions in the context of your local protocols and medical director authorization.
    
9. Patient assessment hands-on skills practice.
   1. Vital sign assessment: blood pressure, radial pulse, mental status
   2. Lung sound auscultation
   3. History taking
       
10. ALS provider manikin simulation practice based on your local protocol for synchronized cardioversion.
     
11. Debrief and summary.