TREATMENT OF UNSTABLE

VENTRICULAR DYSRHYTHMIAS
Clients with ventricular dysrhythmias are considered to be unstable if they have altered mental status,
hypotension, chest pain, dyspnea, pulmonary edema, or ischemic changes on EKG. These signs and
symptoms are caused by compromised cardiac output, which is fatal without emergent intervention.
The nurse should:
Assess: Alert: Intervene:
• Level of consciousness Call for help: In client without a pulse, initiate CPR
• Pulse (present vs absent, characteristics) 911 in community or code immediately. Work with team to provide
• Cardiac rhythm on monitor team in hospital the appropriate transthoracic shock, as
indicated by rhythm and presence or
• Vital signs
absence of pulse.
• Symptoms, if client is able to report

Ventricular tachycardia Ventricular fibrillation

• Rapid heart beat arising from ectopic foci in the ventricles • Irregular electrical activity originating from multiple
• May occur with or without a pulse sites within the ventricles
• The ventricles quiver instead of pumping blood.
Torsades de Pointe
• Client presents without a palpable pulse.
• A polymorphic form of ventricular tachycardia
• May occur with or without pulse

Yes PULSE? No

Synchronized cardioversion Initiate advanced cardiac life support ACLS) algorithm

Electrical shock used Electrical shock used

Cardioversion Cardioversion
to terminate a on clients in V-Fib
Cardioversion Cardioversion life-threatening cardiac Defibrillator or pulseless V-Tach.
pads machine rhythm in clients with pads Depolarizes cardiac
a pulse. cells, temporarily
Lower energy than stopping all
defibrillation and shock cardiac activity.
is synchronized to May allow the heart’s
occur on the R wave. natural pacemaker
May allow heart to to regain control and
resume normal sinus restart in normal sinus
rhythm. rhythm.

Post-acute management
• Assess underlying cause. Epinephrine + Amiodarone
If unresponsive to
• Consider implantable cardioverter-defibrillator (ICD) Defibrillate
defibrillation after
placement.
3 shocks
• Antiarrhythmic medication per underlying condition

NOTES

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