Pulseless ventricular tachycardia | ACLS-Algorithms.com


  1. Anonymous says

    Hi good morning everyone
    What is the step to follow in a patient who is awake, conversant with unstable BP (palpatory 50)
    Is it possible that a pulseless patient awake and conversant?


    • Jeff with admin. says

      First question: if you have a patient who is awake, conversant and has an unstable blood pressure you would want to determine the cause for the unstable blood pressure and treat it. If the cause is related to a tachyarrhythmia that is causing the patient to be unstable then synchronized cardioversion would be the appropriate treatment.

      Second question:
      If the patient is truly pulseless then they will not be awake and conversing with you. They have a pulse. You just can’t feel it.

      In the situation, the patient probably just has poor blood perfusion and would need to be treated for that with the appropriate treatment.

      Kind regards,

    • Harley says

      I think that being pulseless would mean no cardiac output therefore patient would not be perfusing and would not be Conscious

  2. Lyn says

    Hello! What if the first rhythm was asystole/PEA and you were able to give the first dose of epi and then after rhythm check, it becomes a shockable rhythm so we shift to the left branch of the algortihm, do you still give epi after 3 mins starting from the first administration (when it was administered for a nonshockable rhythm) or will the administration and counting of 3 mins be restarted after the 2nd shock? In other words, is the cycle of epi administration restarted when you shift from a nonshockable to a shockable rhythm?

    Thank you very much!

    • Jeff with admin. says

      Within the left branch of the cardiac arrest algorithm, epinephrine is always given during chest compressions. You’re the first dose is given, epinephrine is basically on its own timeline and is given every 3 to 5 minutes so you would be fine continuing with the same timeline from the PEA/asystole right branch.

      Kind regards,

  3. Liz says

    How can you tell the difference on ECG between PEA & pulseless v. tach? I know PEA is when a patient has a rhythm on ECG but has no pulse. Pulseless V. tach also has a rhythm but no pulse.

    • Jeff with admin. says

      Any type of ventricular tachycardia that does not have a pulse will be considered pulseless ventricular tachycardia. It will never be considered PEA.

      Even though pulseless ventricular tachycardia is technically Hey form of pulseless electrical activity, for the purposes of advanced cardiac life support, it is not because it is treated with the left branch of the cardiac arrest algorithm rather than the right branch of the cardiac arrest algorithm.

      This is because pulseless ventricular tachycardia responds very well to high energy unsynchronized shocks.

      Kind regards,

    • Jeff with admin. says

      Normal Saline is fine. The reason why it is OK is because the bolus of amiodarone will be pushed in by the normal saline, and there will be an insignificant amount of mixing. Definitely not enough time or amount to cause any type of precipitation.

      Kind regards,

  4. Hilgendh says

    Hi, Jeff! Thank you so much for this site! Reading your answers to everyone’s questions is so helpful as well!

    Sorry if i missed someone already asking this, but regarding monomorphic V-tach:
    ACLS says if the patient is pulseless, give an unsynchronized shock of 120-200J, if they are unstable with a pulse give synchronized shock of 100J. My question is, if a v-tach rhythm is synchronizable, even if there is no pulse, why would we not synchronize? Does the extra 20 jouls make that much of a difference? Is there a physiological reason for this? Or is it just to make the algorithm easier?

    Thank you!!!

    • Jeff with admin. says

      First, thanks for your encouraging words!

      Pulseless monomorphic VT responds quite well to unsynchronized defibrillation. In all likelihood, it would respond well to synchronize cardioversion as with VT with a pulse.

      There is not a physiological reason for this, but since it is treated different than PEA and responds well to defibrillation it is included in the left branch of the cardiac arrest algorithm. It does simplify things.

      Kind regards,

  5. Rhonda Gaines says

    What a nice break to stop, read these comments and questions, it’s like even more review but personal. Thanks Jeff for providing a better way to learn and study. Far cry from the days of 2 long painful days of anxiety and tears….looking forward to PALS now

  6. Edward says

    Hello sir,

    In your answer above (Q. 6) you mentioned to give Epi every 3-5 min regardless of anything else, and immediately after giving shock, so what if Amiodarone and Epi coincide together can I give them back to back or wait on Amiodarone till next CPR Cycle

    Thank you

    • Jeff with admin. says

      Yes, you can give amio and epi back to back during the same round of CPR if it is time for both of them to be given. Give epi then flush with 20 ml NS, then give amio and flush with 20 ml NS.

      Kind regards,

  7. Raymond Navarro says

    Good day! I just wanted to ask in the cardiac arrest algorithm during cor and lifepack advise no shock and continued 4 mins of cpr what do you mean about treat reversible causes sir?

    • Jeff with admin. says

      Treating reversible causes means that you would attempt to identify any causes of the cardiac arrest that may be reversed. You would want to quickly review the H’s and T’s of ACLS to see if you can identify any possible reversible causes. Here is a review that you can look over which will explain the most common reversible causes that might be discovered.

      H’s and T’s of ACLS

      Kind regards,

  8. Raymond Navarro says

    Hello sir gud day I just want to ask after 2 mins of cpr and lifepack advices no shock, and continued 4 mins of cpr. In the cardiac arrest algorithm,what you mean to treat reversible causes?

    • Jeff with admin. says

      In the case that the cardiac arrest is being caused by something that is reversible like opioid overdose or foreign body airway obstruction you would want to identify this and treat it.

      Kind regards,

    • khaled says

      it is known as five Hs and five Ts

      Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia
      Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), and Trauma

  9. Mrs Nakajima says

    General question here. What is the difference between the ‘red’ shock icon and the ‘yellow’ shock icon? Is it voltage difference?
    Great site. Need to cram all this information in my head again in a month, but need certification to access more ‘opportunity’ to become familiar with using the knowledge, so am understanding why acquisition of this body of knowledge is a routine and periodic yearly requirement!

    • Jeff with admin. says

      The first yellow shock icon is representative of the initial shock. The red shock icon is representative of all shocks that come after the initial shock.

      Please let me know if you have any other questions.

      Kind regards,

  10. Marcie says

    i have been away from acute care/critical care nursing for 8 years and now i am going back and needs ACLS certification. Are you posting the latest or current practice or changes now in practice? i don’t have a book but have registered on February 17 Flexd Med.

    • Jeff with admin. says

      Everything on the website is current with the latest American heart Association guidelines. The entire website is designed to be used as a standalone resource or in conjunction with the American Heart Association provider manual’s. I do have many students that use the site without the provider manual and do great.

      Kind regards, Jeff

  11. francis s says

    I have been using your site since 5 years for my ACLS ,I found that it was so helpful and yesterday I did my ACLS . I referred this site to my friends too
    Thanks Jeff
    Great site

  12. Wendy Gaus says

    Just clarifying….What do you mean by IVP? I suspect you mean IV Push and not IVPB or intravenous pyelogram (IVP) which is what it traditionally stands for. Thanks, Wendy

  13. Laura Vandewaal says

    This is the most interesting conversation I have run into and make refreshing of the coarse so easy l love it


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