Pulseless Ventricular Tachycardia

Pulseless Ventricular Tachycardia

Ventricular Tachycardia

The pulseless ventricular tachycardia rhythm is primarily identified by several criteria. First, the rate is usually greater than 180 beats per minute and the rhythm generally has a very wide QRS complex.

Second, the patient will be pulseless and third, the rhythm originates in the ventricles. This is in contrast to other types of tachycardias which have origination above the ventricular tissue (in the atria).

Not all ventricular tachycardias are pulseless and therefore, pulselessness must be established prior to beginning an algorithm. This is accomplished simply by checking a carotid or femoral pulse.

Pulselessness with a tachyarrhythmia occurs because the ventricles are not effectively moving blood out of the heart and there is therefor no cardiac output. Many tachyarrhythmias of a rate >150 will deteriorate into pulselessness if timely treatment is not given.

Pulseless ventricular tachycardia is treated using the left branch of the puslesless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.
Pulseless Arrest Algorithm Diagram.

Play the video below to see what a Pulseless Ventricular Tachycardia will generally look like on a defibrillator monitor. Allow several seconds for video to load.


  1. Steve says

    This is fantastic!

    I keep hearing different medical treatments for VT and VF. Is it possible for you to clarify once and for all the medications you would use, including dosages. Many thanks. Great site.

  2. im1coolrn says

    I won’t be taking ACLS without resubscribing to your site. This way of presenting the material makes it SO much easier to digest and remember. Thanks!

  3. GabrielMolina says

    Estoy contento del ingreso a este servicio para compartir preguntas y experiencias de la capacitación, muy interesante y practico.

  4. yrrehSillenipS says

    Every time I log on, this just gets better and better. I have been in critical care since 1999, and have always had a fear of not remembering the algorithms, especially the way they are represented in the AHA workbooks. These explanations are enabling me to put logic into each step of a code, rather than just rote memorization. Logic means increased memory retention for me.
    Also, I appreciate that someone has spellchecked the material.
    The best part is that I signed up for a year, so that after the test, I can continue to review things I haven’t used, but are bound to come up in some future code situation.

  5. lkatminw says

    I just registered onto this site and I am in awe of how resourceful it is. Reading the comment/responses section is helping answer my questions about algorithms. This is great! The responses are toned down,which is how I learn best. Thank you.

  6. kcap says

    Hello Jeff,

    With the 1mg of Epinephrine, is that 1:1,000 or 1:10,000 dilution? Also, is the Epinephrine diluted prior to pushing the 1mg IV? Is it recommended to use Lidocaine as an antiarrhythmic, or is it more predictable to stick with Amiodarone?

    Thank you,

    • says

      Epinephrine vials are also labeled by concentration of a ratio of medication per mL.
      Most crash carts in the United States now come with pre-made 1:10,000 (1mg/10ml) syringes of epinephrine to help reduce the error of giving undiluted epinephrine. If you are using 1:1,000, you must dilute to 1:10,000 prior to administration for ACLS.
      Amiodarone is the first-line antiarrhythmic for the cardiac arrest. Lidocaine can be used if amiodarone is not available.

      Kind regards,

      • ctruscott says

        This is confusing regarding the dilution of Epi. You said if you are using Epi for ACLS, you must dilute to 1:10,000 which would equal 0.1 mg/ml. But the standard dose for Epi in V-Tach and V-Fib is 1 mg. Which is the correct dose then 0.1 mg/ml or 1mg/ml?


  7. masoroti says

    Will be my first time to take the AC LS. Just had a good feeling about this site.I like what users have to say about it!

  8. says

    I think what MaryAnn was commiting on was on the Algorithm of PEA/Asystole it’s not a shockable, but didn’t understand once you give medication/CPR it can then become a shockable rhythm (where the yes and no arrows are).

  9. Willard says

    This is my second time using this site to prepare for my ACLS recertification. I find it very affordable, informative, user friendly, easy to navigate and understand. Thank you from the bottom of my Paramedic patch. Eng/PM Bill Mills

  10. says

    I just stumbled over this site by accident , the wealth of information and the way it is formulated is amazing . Excellent job !!!!! Thank you.

    • says

      I could not find any reference to PEA on this page.
      There is a common misunderstanding when referring to pulseless ventricular tachycardia. Some people think that pulseless ventricular tachycardia treated as PEA.
      This is incorrect. Pulseless ventricular tachycardia is treated the same way that ventricular fibrillation is treated.
      With unsynchronized high-energy shocks.
      This is the left branch of the pulseless arrest algorithm.
      PEA and asystole are treated using the right branch of the pulseless arrest algorithm.

      Kind regards,

  11. says

    I’ve been taking ACLS since its inception, and this site is certainly more interesting for the purpose of reviewing, as compared to reading the book. I find the questions and feedback from other people not only educational, but also very interesting. Thanks for a great site!

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