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, therefore, 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 cardiac arrest algorithm. Click below to view the cardiac arrest algorithm diagram. When finished click again to close the diagram.
Cardiac Arrest Diagram
Click to view, and click again to close the diagram.
PALS Cardiac Arrest 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. (4.03 mb)
Click for next Rhythm Review: Ventricular Fibrillation
Top Questions Asked on This Page
-
Q: What happens after the 2nd dose of Amiodarone is given and the patient is still in the same rhythm? Do we give a 3rd dose immediately or rhythm usually changes after 2nd dose?
A: A 3rd and even a 4th dose of 150 mg amiodarone may be administered. The only thing that needs to be taken into consideration is the 2.2-gram maximum dosage for 24 hours. Also, it is unlikely that the rhythm will remain VF or pVT long enough for you to get to the 3rd or 4th dose.
-
Q: What does refractory VT or VF mean?
A: Refractory pVT or VF means that the VF or pVT does not convert to a perfusing rhythm and continues to persist in spite of multiple attempts at conversion with defibrilation, acls drugs, and high quality CPR.
-
Q: After initiating CPR and assessing the rhythm, the patient is in VF/ pVT and the first shock is given, and CPR for 2 mins. Then rhythm check and in VT, should the pulse be checked to confirm pVT?
A: If there is no rhythm change and the same waveform of VT continues, you would not need to perform a pulse check. Performing the pulse check would delay the continuation of chest compressions. Once VT is pulseless it is very unlikely that any VT will be able to produce life-sustaining cardiac contractions.
Kamini says
Loved the presentation in Vedio… Very helpful
tylah434@yahoo.com says
good infor first time user
Mary says
Thanks for this site, it is giving me great comfort and building confidence.
Jeff with admin. says
So glad it is helping. Kind regards, Jeff
amyamberly says
From Alberta, Canada. Thanks for the help! Am doing my course this week
Soliton61 says
Question: What is the treatment for v tach with a pulse?
Jeff with admin. says
Reply:
The treatment for ventricular tachycardia with a pulse is multifaceted. The tachycardia algorithm outlines in detail the multifaceted treatments for ventricular tachycardia with the pulse.
A review of ventricular tachycardia with a pulse can be found here:
https://acls-algorithms.com/acls-video-review/tachycardia-algorithm-review-1
And here:
https://acls-algorithms.com/acls-video-review/tachycardia-algorithm-review-2
Kind regards,
Jeff
CECRN says
If someone goes from PEA or asystole algorithm to pulseless VT or VF to you have to wait after second or third shock to administer amniodarone since you have already been administering epinephrine?
Jeff with admin. says
Amiodarone would be give after the 3rd shock according the to the guidelines. However, remember that the guidelines are just recommendations. If a team leader felt it was appropriate to give the amiodarone after the first shock then that would be ok. The AHA guidelines are simply guidelines to guide healthcare providers in emergency situations.
Kind regards,
Jeff
angelika6082 says
why is Amiodarone given after 6 minutes of CPR?
Jeff with admin. says
Starting in 2010 there was a focus placed on high quality CPR and early defibrillation as the foundation of ACLS.
In order to place all interventions in sequence of importance and to deemphasize the use of medications amiodarone was placed in the order that it is in.
Kind regards,
Jeff
lminch says
When is Lidocaine Given and how much? Can Lido and amiodarone both be used? Has Amiodarone proven to be more effective than Lidocaine?
Jeff with admin. says
Here is a page on the site about Lidocaine: Lidocaine and ACLS
Amiodarone has been proven to be more effective antiarrhythmic than Lidocaine. If amiodarone is available, lidocaine will not be used. If amiodarone is not available lidocaine can be used.
Kind regards,
Jeff
tecintron says
Very helpful!! Loved the video and music!! LOL
Thank you!
Elaine12 says
light bulb came on as to when and why you check or don’t ck for a pulse .ie pulseless rhythm goes into vf or asystole you know that is pulseless ,so you start cpr no reason to ck for a pulse
Kar11968 says
This is a great program! My ACLS recert test is coming soon. I only wish I found it 2 month ago when I starting reviewing. Thank you for creating this program.. It is well worth the time and $!
Jeff with admin. says
I am so glad that the site has been helpful for you. Kind regards, Jeff
saeidmira says
Question: When should we check for a pulse in the pulseless algorithm?
Jeff with admin. says
You should only check for pulse if you do a rhythm check and there is a rhythm change and the rhythm could be a perfusing rhythm.
For instance, if the rhythm check shows bradycardia or tachycardia, you would check for a pulse. If the rhythm changes from pulseless ventricular tachycardia to ventricular fibrillation or asystole, you would not check a pulse, but immediately continue CPR.
Kind regards,
Jeff
cpate22 says
I, too, enjoy the music. It snags the interest just slightly above the level of which the topic itself is limited. :):):)
david f. karibo d.o. says
greast music video to the point,keep them coming
Dexterino says
Damn, the music in the VT Video Presentation is intense and suspenseful. LOL