Pulsed ventricular tachycardia: a case study
Ventricular tachycardia (VT) is an arrhythmia that originates from the ventricles of the heart and presents as a wide and prolonged QRS complex on the electrocardiograph of greater than 120 milliseconds, with a heart rate of over 100 beats per minute. VT can occur as a pulsed or pulseless rhythm. Pulseless VT occurs when the ventricles cannot effectively pump blood out of the heart, therefore resulting in no cardiac output. Pulsed VT can manifest with the patient presenting asymptomatically, or with symptoms of reduced cardiac output resulting from poor ventricular filling. There is the potential for the patient to quickly become haemodynamically unstable if not treated. This article discusses a case of pulsed VT, diagnosed and treated out of hours in an acute hospital.
This article will focus on a case seen in clinical practice, from the perspective of the first author, who was at the time a trainee advanced clinical practitioner (ACP) working in the hospital out of hours team within an acute hospital. To maintain the patient's privacy and dignity as per the Nursing and Midwifery Council (2018)Code, the pseudonym ‘Max’ will be given to the patient.
Max, a 65-year-old gentleman with no prior past medical history, had been admitted to the emergency department as a ‘resus pre-alert’ at the beginning of this admission 1 week previously. Ambulance crews are required to pre-alert the receiving hospital of any patient who may require immediate clinical interventions, or to activate any relevant protocol or treatment pathway (Royal College of Emergency Medicine, 2020). Max had described a history of progressively feeling dizzy and experiencing shortness of breath with fevers following a fall from his bicycle 5 days earlier. Max called the 111 service, who promptly sent a paramedic crew to his home. They found Max to be in pulsed ventricular tachycardia (VT) of a rate of 180 beats per minute, with a blood pressure reading of 125/70, and a oxygen saturation level of 80% on 15 litres oxygen via a non-rebreathe mask. This saturation level could be attributed to poor cardiac output, however, given the history of trauma, this raised the suspicion of a possible respiratory complication. Of note, the patient also had a pyrexia of 38.7 °C. It was therefore very important to rule out the possibility of rib fractures, lung contusions and chest infections in addition to the initial presentation of pulsed VT.
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