Hi welcome back. I'm Mark
from ACLS Certification Institute. In today's video segment we're gonna cover another
megacode
algorithm. However, in this one our patient starts out
with a narrow complex tachycardia. So I wanna take a few minutes and just
review narrow complex tachycardia. Now remember, a tachycardia is any rhythm that has
a ventricular rate
over a hundred. What we're concerned about in the adult is when
the ventricular rate exceeds 150. That's less than 150
and I live in a world where anything can happen but if it's less than 150
think it as there's another cause for this is patiently dehydrated, are they
the ages, are they having a reaction to drug, is another cause besides the primary
cardiac event?
If ventricular rate is over 150 we're thinking, yeah this could be cardiac in origin and
we're going to treat that appropriately.
So what makes no complex tachycardia a narrow complex tachycardia?
Generally we're looking at the width of the QRS complex.
The width of the QRS complex should be
less than or at least not greater than 0.12 seconds
If its greater wider than, then that's a wide complex tachycardia;
possibly ventricular in origin and that is a topic for another video.
Let me talk about symptoms for Americans. can be a little confusing or talking about
symptoms
and no complex tachycardia I'm the patient may be symptomatic
that is to say they have horrible diseases they have some palpitations and
their chest
but their blood pressure is a bust ninety systolic they're not showing
serious signs of shock
well this is a relatively stable patient their hemodynamically stable
so we have some time we got some wiggle room this is the patient that's gonna
receive medications
look at Yahoo them here the first thing you notice is hypertension
this is where these other sites a shock usually right from poor skin color
altered mental status
all this comes from hemodynamic instability this is the basic
you fire up the old let mister three thousand said it first thing to give me
hope so
so treating check a car news consumption
be confusing so here's my pits for a quick treatment eh cards
patient number one symptomatic hemodynamically stable
wintry precipitation with medication or you can try legal maneuver first
and the PC bear down trends without the cheese pizza
haven't person with the boil hardly
trying to blue who have been strong can stimulate the Vegas rooms
all the hard second patient
symptomatic the more dynamically unstable start blood pressure less than
90
repeat this place with the media synchronized turnovers
at different location synchronized cardioversion
flirtation no complex tachycardia
no holes listen PA only lead author
paar world so revealed
symptomatic stable medication
symptomatic unstable synchronized cardioversion
no happen second turn the whole
SPEA will go on to them
so let's go ahead and get into our many cold cereal for today
today working in the ambulance so it's going to be more injury and selling
for them
prehospital hyperspace in the day
on 16-year-old male you call the seal a local bar
I'm if I'm Jones sitting at the bar yes what's going on
so is about 30 minutes ago we begin feeling light-headed
is the came on almost certain just how much is even drinkin
his ears are very good at all he feels paul also quick radio Paulson
feels rapid ready now the team leader on this call
i'm concerned. assigning roles I was the only permitted to put him on oxygen
with him on a minor let's get some vital signs
started maybe Munich blood pressure
ballot question 110 007 respiratory rates about 20
clear bilaterally rameriz PO to use ninety-five percent
we want to go to the monitor we see this no complex tachycardia
rating 168 he symptomatic
but he's hemodynamically stable so how we treat those medications
on personal choice definitely six milligrams
practice IV push now remember when I said before
all IV medications into cardiac arrest have to be followed with the 20 cc
syringe poses saline
to help you set for the heart well the station has been arrested
but we're losing at Tennessee and didn't see
always has to be followed with a 20 cc syringe bowlers to help push it to the
heart
the reason is because then seen has such as short nap
only a few seconds want to turn the body starts to wear off
very quickly so how do you actually give the visitors the administration
here so I did and take the a dozen
and pulling into the port closest location I take me 20 cc syringe the
ceiling
put into the next board downstream clap off to sleep
and I synchronize the Ministry issue with my partner 3
to one I put he pushes we get you can see the patients quickly as we can
you have to get the addenda see the heart as fast as you can
and the greatest concentration that you can so there has the most opportunity to
work
the
now all my hard work you're doing is you're already getting the IV the
patient
masterpiece in to bear down that's a little far
so K it happens clear a couple people over the burger we keep going because
we're medical professionals
we get the Tennessean before we can get you didn't seem
other box you ready to go but Purdue thinking another bullshit Booker should
now see the book pressures a do-over pop
patient starts to look very pale starts to roll of the bar stool we've gotten
down to the ground then out the patient has become
hemodynamically unstable we're gonna move into synchronized cardioversion
immediately the
the clinical moment you synchronize
cardioversion on that is different than the tribulation
so you go to whatever monitored approval if you have
is talking to separate the tribulation but you have to press the Save button
you know that it's insane because a couple things will happen one
on the screen it should say saying and then also
you know sizzle hash marks above the are ways that some Islanders
seeking up to the cardiac rhythm so that we don't inadvertently
shock to pay should during the road to refractory period
do that because be set I'm
who's going to synchronize this shock with the patient's her
which means in most cases when you depress the button to discharge data for
greater
you have to press and hold up unlike when you shocking just a pretty lady
you shocked it cools off is synchronized cardioversion
you may have to press and hold the button weekly machine to sync up with
the patient's cardiac rhythm
and then it will deliver the shock the
however weeks after a cold the pieces Paul
so now we have and hero complex
removing but no poll I'm
this is PE Paulson's electrical
activity immediately begin chest compressions
this patient doesn't have a pulse which is strange because you seeing a regular
you know how close with them on the monitor
but its Peej very Minister medications
we continue chest compressions first drug of choice
after nap one 10,000 IV push
you repeated every three to five minutes and continue
quality chest compressions now we do you reach isn't he's also
try to figure out why this piece is in the through the ones the underlying
causes that
hypoxia hypokalaemia
nasa dosis hyper hypokalaemia
hypothermia coronary thrombosis
pulmonary thrombosis credit Campana
tension pneumothorax toxins
continue the chest compressions considered advanced airway
dozens PC need to be intubated the so after continuing
just compressions epinephrine ministration
the best their way the patient ever going to Pauls
then back to work
first
the lol
not her as you working the patient
you check for polls now you have a pulse you purchase a blood pressure
you have a blood pressure 110 over 70 fantastic
so remember when treating the patient with new complex tachycardia
what going to therapy dissipation hemodynamically stable
if they're serious signs a shock hypertension
secret as cardioversion the patient as a stable blood pressure
and maybe symptomatic maybe didn't see
may have just worry hemodynamically stable that's when you get the
medications
I'm I'm mark brace yourself Picatinny
to datenblatt from day