Treatment of Ventricular Tachycardia (Nursing)

00:01 Hi, welcome to our video series on the electrocardiogram.

00:05 In this one, we're going to talk about something pretty dramatic.

00:08 We're talking about the treatment of ventricular tachycardia.

00:12 Now there's your old friend, normal sinus rhythm.

00:16 We're going to review why this is not normal sinus rhythm, And it's V tach Heart rate is fast, the rhythm is regular, but it's only ventricular.

00:28 We can't see a P wave, so we can't measure the PR interval, and the QRS is pretty weird looking and it's greater than 0.12.

00:39 Now we've got that graphic for you again So you see where it's all happening where all the activity is going down is the ventricles.

00:46 Because ventricular tachycardia occurs when the electrical signals within the lower chambers that we call the ventricles, all happen in there and it causes the heart to be too quickly.

00:58 Now this is an emergency.

01:04 You will see people go flying into a patient's room if they see this dysrhythmia because you need urgent medical treatment for your patient if they're in V tach, because V tach can lead to sudden cardiac death.

01:19 So the goal of treatment of V Tach is to restore a normal heart rate and function so we can perfuse the patient's body.

01:28 Okay, defibrillation and cardioversion.

01:30 This is where it gets pretty exciting.

01:32 Unless you're the patient, then it's not quite as interesting but for those of us to be ready to help a patient in V tach, here's what you need to know.

01:42 See, the acute treatment somehow involves delivering a jolt of electricity.

01:47 There's a couple ways we deliver that either in defibrillation or cardioversion.

01:52 So, if a patient is acutely experiencing ventricular tachycardia, we're going to actually deliver a jolt of electricity to the heart.

02:01 Now, we can use this with a defibrillator, or with a treatment called cardioversion.

02:06 And we usually typically use that with patients with a pulse, who are unstable.

02:11 So on the left, you see the patient with defibrillator pads and see how those are aimed So the electrical jolt can go right through the heart.

02:21 Now you'll see wires that go off the screen there.

02:24 That's because that is hooked up to a defibrillator machine.

02:28 We used to have to place the paddles long ago on a patient's chest, but that makes the health care provider have contact with the patient.

02:37 So it is safer for everyone if you put the sticky patches on in the correct spot, and then you just push a button to defibrillate the patient.

02:47 Now, I'm going to break this down a little bit more for you, but we have some treatment called Advanced Cardiac Life Support.

02:55 Now that is a whole course so we're not going to break that down for you, because that's not what we're doing here.

03:01 We just want you to have an overview of ways that we could treat V tach.

03:07 Alright, here's one of my favorite study tips.

03:10 When you're trying to learn about two concepts, it's important that you know the similarities and the differences.

03:17 So line them up right next to each other and compare them.

03:20 For example, I'm going to show you on defibrillation versus cardioversion.

03:25 On the left, we have defibrillation, think of this as a boom, this is a really big tool.

03:33 It's not synchronized to the heart rhythm, and we use it for patients who are in cardiac arrest meaning pulseless V Tach which we're talking about here, or even V fib.

03:43 Now defibrillation is with some pretty high energy joules.

03:48 We're not giving you the exact numbers here, because you'll learn that in Advanced Cardiac Life Support.

03:53 This is just an overview for you.

03:56 So defibrillation, it's big and it's not synchronized.

04:00 We use it for serious rhythms like pulseless V tach, or V fib, and we're gonna use a pretty big jolt.

04:07 Cardioversion, on the other hand, it's a little more elegant.

04:12 It's synchronized on the patient's R wave.

04:16 It's only used with patients who are unstable hemodynamically and still have a pulse, but they're showing us that this is not going well for them.

04:25 They can't keep their blood pressure up.

04:26 They're having chest pain, any signs that show us they are not hemodynamically stable, makes them a candidate for us to consider cardioversion.

04:36 Now defibrillation, Boom! Those are the big joules.

04:40 Cardioversion is a lower energy.

04:43 Think of it more as a dance.

04:45 So cardioversion is synchronized, defibrillation - not synchronized.

04:50 We use it for pulseless V tach or V fib.

04:54 For cardioversion, we use unstable patients who have a pulse.

04:59 They still have the V tach but they have a pulse.

05:03 High joules for defibrillation, lower energy joules for cardioversion.

05:08 Now that you have kind of the basic foundation of the difference between defibrillation and cardioversion, let's dive a little deeper.

05:15 So defibrillation is best when the cardiac cells are not anoxic, and the patient is not acidotic.

05:23 Now let's talk about what those are.

05:25 Anoxic means "without oxygen." So if the cardiac cells specifically have been without oxygen for a very long period of time, we're going to have poor results.

05:36 Acidotic refers to the pH of your blood, normal is 7.35 to 7.45.

05:44 Someone who is acidotic will be lower than 7.35 See, anoxic cells means oxygen, they've been deprived of it for a significant period of time, And acidotic is another indication that woah, things have gone really downhill.

06:02 These patients are not the ones who most benefit from defibrillation.

06:08 Now it's best to perform the defibrillation within 15 to 20 seconds of the arrhythmia onset.

06:14 This is the best method to terminate V tach.

06:18 Have you ever wondered why you go to the gym or when you go to a school ballgame that there are those defibrillators around on the wall? That's because if you're going to save someone from V tach, whether they're a young athlete, or up to an elderly person who's watching the game, you have to perform the defibrillation as quick as possible to try to save their life.

06:41 Now a defibrillator, is that passes that direct current through the heart, so it depolarizes the cells.

06:48 Now there's a period of repolarization that may allow the SA node to resume as the pacemaker.

06:55 So that's a very long way of saying when we put this large electrical charge through the heart, what happens is it depolarizes the cells and then when things repolarize, that may kick the SA node in, it's a pretty dramatic reset of someone's heart and if it works, it's brilliant and it is amazing to see.

07:20 Now cardioversion can sometimes be similar to defibrillation, but remember, it's much more dramatic, but in cardioversion the shock is programmed to be delivered during the QRS complex so it's that more synchronized version.

07:36 Ventricular tachycardia ablation is a procedure to eliminate the areas of the heart where there are erratic electrical signals arise that are causing the heart to beat ineffectively.

07:47 The procedure starts with the insertion of a catheter sheath into the patient's femoral vein.

07:53 This will be used as a guide to insert a catheter into the sheath to guide it through the venous system until it reaches the patient's heart.

08:03 In the heart, the doctor will guide the catheter to the area that is causing the arrhythmia.

08:09 The tip of the catheter either emits a hot or cold energy that will allow the physician to ablate the tissue.

08:17 This ablation causes this area to stop firing those erratic signals and therefore stops the arrhythmia An epicardial needle is used to gain access to the epicardial space between the epicardial membrane surrounding the heart and the outside surface of the heart.

08:35 The ablation catheter is placed in the epicardial space.

08:39 The outside surface of the heart is mapped - coronary arteries and the phrenic nerves - before the ablation is completed in order to avoid injury.

08:50 The implantable cardioverter defibrillator is also called an ICD.

08:55 The ICD will detect a rapid heartbeat coming from the ventricles and deliver a shock to reset the heart.

09:03 Now, this is what my mom had placed and also with a pacemaker portion of it.

09:08 This is a pretty incredible device, because you know that we need to get the shock there within 15 to 20 seconds if we know a patient is at risk for this dysrhythmia and we put the cardiodefibrillator right in their chest wall, they have a much better chance of survival.

09:27 So let's wrap up this portion of our video series.

09:30 Sustained V tach is a life threatening emergency that can be treated acutely with cardioversion if the patient has a pulse, or defibrillation if the patient does not have a pulse.

09:42 Ventricular ablation and implantable cardiac defibrillators (ICD) are the options for long term treatment of recurring ventricular tachycardia.

09:52 Thank you for watching this part of our video series.