Difference between revisions of "Pulseless ventricular tachycardia interventions"

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{{CMG}}; {{AE}}{{Aisha}}
 
{{CMG}}; {{AE}}{{Aisha}}
 
==Overview==
 
==Overview==
There are no recommended therapeutic interventions for the management of [disease name].
+
Immediate defibrillation is the main intervention for pVT.
  
OR
+
==Defibrillation<ref name="urlWhat are the treatment options for pulseless ventricular tachycardia (VT)?">{{cite web |url=https://www.medscape.com/answers/159075-67727/what-are-the-treatment-options-for-pulseless-ventricular-tachycardia-vt |title=What are the treatment options for pulseless ventricular tachycardia (VT)? |format= |work= |accessdate=}}</ref><ref name="pmid32119354">{{cite journal |vauthors=Foglesong A, Mathew D |title= |journal= |volume= |issue= |pages= |date= |pmid=32119354 |doi= |url=}}</ref>==
  
[name of intervention] is not the first-line treatment option for patients with [disease name]. [name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
+
*As opposed to other unstable [[Ventricular tachycardia]], PVT should be managed with '''immediate [[defibrillation]]'''. A high energy defibrillator (150-200 J on biphasic and 360 J on monophasic) should be used for the initial shock dose, followed by an equal or higher shock dose for successive shocks
 +
*5 CPR cycles each containing 30 chest compressions and 2 breaths should be done after the first shock is delivered. Each subsequent shock should be followed by airway management with Oxygen delivery, and IV access with [[vasopressors]].
  
OR
 
  
The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
+
===ACLS Cardiac Arrest Algorithm===
  
OR
+
{{familytree/start |summary=PE diagnosis Algorithm.}}
 +
{{familytree | | | | | | | | | | | | | A01 | | | | | A01='''Adult Cardiac Arrest'''}}
 +
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
 +
{{familytree | | | | | | | | | | | | | A02 | | | | | | A02='''Start [[CPR]]'''<br>Give oxygen<br>Attach monitor/defibrillator}}
 +
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
 +
{{familytree | | | | | | | | | | | | | A03 | | | | | | A03='''Rhythm shockable?'''}}
 +
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | }}
 +
{{familytree | | | | B01 | | | | | | | | | | | | | | | B02 | B01=Yes| B02=No}}
 +
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
 +
{{familytree | | | | C01 | | | | | | | | | | | | | | | C02 | C01='''[[VF]]/[[pVT]]'''| C02='''[[Asystole]]/[[PEA]]'''}}
 +
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
 +
{{familytree | | | | D01 | | | | | | | | | | | | | | | |!| | D01=Shock}}
 +
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
 +
{{familytree | | | | E01 | | | | | | | | | | | | | | | |!| | E01=<u>'''''Box A:'''''</u><br><br>'''[[CPR]] 2 min'''<br>IV/IO access}}
 +
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
 +
{{familytree | | | | F01 |-| F02 |~|7| | | | | | | | | |!| | F01='''Rhythm shockable?'''| F02=No}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
 +
{{familytree | | | | G01 | | | | | |:| | | | | | | | | |!| | G01=Yes}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
 +
{{familytree | | | | H01 | | | | | |:| | | | | | | | | |!| | H01=Shock}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
 +
{{familytree | | | | I01 | | | | | |:| | | | | | | | | I02 | I01=<u>'''''Box B:'''''</u><br><br>'''[[CPR]] 2 min'''<br>[[Epinephrine]] every 3-5 min<br>Consider advanced airway<br>and [[capnography]]| I02=<u>'''''Box C:'''''</u><br><br>'''[[CPR]] 2 min'''<br> IV/IO access<br> [[Epinephrine]] every 3-5 min<br>Consider advanced airway<br>and [[capnography]]}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
 +
{{familytree | | | | J01 |-| J02 |~|C| | | | | | | | | J03 |-| J04 | J01='''Rhythm shockable?'''| J02=No| J03='''Rhythm shockable?'''| J04=Yes}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | K01 | | | | | |:| | | | | | | | | K02 | | |:| | K01=Yes| K02=No}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | L01 | | | | | |:| | | | | | | | | |!| | | |:| | L01=Shock}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | M01 | | | | | |:| | | | | | | | | M02 | | |:| | M01='''[[CPR]] 2 min'''<br>[[Amiodarone]] or [[Lidocaine]]<br>Treat reversible causes| M02=<u>'''''Box D:'''''</u><br><br>'''[[CPR]] 2 min'''<br>Treat reversible causes}}
 +
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | N00 | | | | | |D|~|~|~|~| N01 |-| N02 | | |:| | N00= Go back to box A| N01=No| N02='''Rhythm shockable?'''}}
 +
{{familytree | | | | | | | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | | | | | | | | |:| | | | | | | | | O01 | | |:| | O01=Yes}}
 +
{{familytree | | | | | | | | | | | |:| | | | | | | | | |!| | | |:| | }}
 +
{{familytree | | | | | | | | | | | |:| | | | | | | | | P01 |~|~|J| | P01=Shock <br> Then, go to box A or box B}}
 +
{{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}}
 +
{{familytree/end}}
  
The feasibility of [name of intervention] depends on the stage of [disease or malignancy] at the time of diagnosis.
+
'''Adapted from Adult Cardiac Arrest Algorithm - 2018 Update'''<ref name="urlwww.ahajournals.org">{{cite web |url=https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000613 |title=www.ahajournals.org |format= |work= |accessdate=}}</ref>
 
 
OR
 
 
 
[Name of intervention] is the mainstay of treatment for [disease or malignancy].
 
 
 
==Indications==
 
 
 
The mainstay of treatment for TT is medical therapy.
 
 
 
 
 
===Recommendations for Autonomic Modulation===
 
 
 
{|class="wikitable"
 
|-
 
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
 
|-
 
|bgcolor="LemonChiffon" |<nowiki></nowiki>'''1.'''  CPR should be performed in patients in cardiac arrest according to published basic and advanced cardiovascular life support algorithms''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]]).''.<nowiki/>
 
|-
 
|}
 
  
 
==References==
 
==References==

Latest revision as of 00:38, 10 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Immediate defibrillation is the main intervention for pVT.

Defibrillation[1][2]

  • As opposed to other unstable Ventricular tachycardia, PVT should be managed with immediate defibrillation. A high energy defibrillator (150-200 J on biphasic and 360 J on monophasic) should be used for the initial shock dose, followed by an equal or higher shock dose for successive shocks
  • 5 CPR cycles each containing 30 chest compressions and 2 breaths should be done after the first shock is delivered. Each subsequent shock should be followed by airway management with Oxygen delivery, and IV access with vasopressors.


ACLS Cardiac Arrest Algorithm

 
 
 
 
 
 
 
 
 
 
 
 
Adult Cardiac Arrest
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Start CPR
Give oxygen
Attach monitor/defibrillator
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rhythm shockable?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VF/pVT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asystole/PEA
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box A:

CPR 2 min
IV/IO access
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rhythm shockable?
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box B:

CPR 2 min
Epinephrine every 3-5 min
Consider advanced airway
and capnography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box C:

CPR 2 min
IV/IO access
Epinephrine every 3-5 min
Consider advanced airway
and capnography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rhythm shockable?
 
No
 
 
 
 
 
 
 
 
 
 
 
Rhythm shockable?
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CPR 2 min
Amiodarone or Lidocaine
Treat reversible causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box D:

CPR 2 min
Treat reversible causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Go back to box A
 
 
 
 
 
 
 
 
 
 
 
No
 
Rhythm shockable?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shock
Then, go to box A or box B
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If no signs of return of spontaneous circulation:
Go to box C or box D

If return of spontaneous circulation:
Start post cardiac arrest care
 
 
 
 
 
 
 
 
 
 

Adapted from Adult Cardiac Arrest Algorithm - 2018 Update[3]

References

  1. "What are the treatment options for pulseless ventricular tachycardia (VT)?".
  2. Foglesong A, Mathew D. PMID 32119354 Check |pmid= value (help). Missing or empty |title= (help)
  3. "www.ahajournals.org".




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