#VTach

[mcatmemoranda]

Always get a stress test on any pt with sustained Vtach

Carvedilol, bisoprolol, and metoprolol decrease mortality in pts with CHF

[bluecollarbisexual]

My dad was a fire captain for calfire. I’m a nurse.

Started watching 911 for the bisexual rep that’s cropped up recently, as I’ve watched much worse shows for a lot less. Was really excited to watch a dumb procedural with a compelling bi storyline since I feel like the experience of figuring your shit out/exploring your sexuality older is a distinctly bisexual experience.

My experience of actually watching the show has been a little surprising though. I went into it mostly just stoked for a queer storyline that I could see myself reflected in. But what’s sticking with me more is the way I’m sort of understanding my father.

It took me until I started working as a nurse to really be able to understand even a fraction of some of the stuff I was only peripherally aware of as a kid. The way he resisted to the point of rage when I was insisting on wanting a motorcycle. The way he would angrily tell me how he spent too many nights scraping people off of the freeway for him to ever condone me buying something like that.

When I finally started working in medicine I began to understand some of his trauma, and the way it made him angry. I’ve learned what it’s like not to be able to save people and to watch them die, sometimes horrifically.

I didn’t go into this show expecting any real insights. I just wanted a fun romp with a queer reward. But weirdly the standout character has been Bobby for me. I see a lot of my father in him. The trauma and the fear and the still putting the turnouts back on and going out there under the influence of some drive that’s 1 part naturally-born hero, 1 martyr, and 1 part adrenaline junkie. And the mark that these kinds of jobs leave on the people who do them.

I grew up hearing stories about horrific motorcycle accidents. About how my father wasn’t there to help my mother when I was a newborn, because he was in San Francisco responding to the devastation of Loma Prieta. About how after one particularly nasty stretch, his brand new turnouts were completely black from blood. About how I didn’t recognize him and hid behind my mother’s leg when he came home after months on the line one fire season.

And this shit did take a toll. I’ve seen a lot of his anger, his inability to cry or mourn even when his father died, his tendency to fly into fire captain mode over even really mild emergencies. He couldn’t even finish the movie Seabiscuit because he couldn’t stomach the kid dying in the beginning of the film. Watching similar struggles of Bobby’s character, the PTSD, and the situations that contribute to it, is making me appreciate the life he lead in a way that not even being a nurse can.

Anyway I don’t expect anyone is particularly interested in this. I’m in season 2, and just a little surprised by the way this show is hitting me and just sorta needed to reflect on it.

If anyone is also in emergency/medical (or has a loved one who is) and has had similar experiences watching this show I’d be interested in hearing from you.

[dogpantry]

me thinking my tachycardia and shortness of breath was because i was out of shape (lol i have such a physically demanding job that this is impossible) and/or because of my anxiety when actually i have inappropriate sinus tachycardia and quite possibly POTS (quite definitely POTS, actually!). i am upset that this is just my reality but glad to know that it is something

[shallowseeker]

I forgive chest compressions on TV because, yeah they could pad up the chest or drag in a dummy to do proper ones...but I get not wanting to go to the trouble for such a short blip of your runtime.

But I cannot and will not forgive shocking a flatline. *shakes fist at the sky*

[tangocardiaca]

Meet Asuka. She is a student at very prestigious college. Very hard-working and focus on goal she will put herself to the limit in order to pass exams. Literally. After her last exam and two sleepless nights she passed out. She was rushed to hospital and placed on ER. The EKG leads, that are placed on her, read her heart rhythm Her heart beats very fast and irregulary. Suddenly she went into ventricular tachycardia. 180 beats per minute and no pulse. Doctors rush to save young woman. They perform CPR, chest compressions and breathing through ambu. AED pads are placed on her chest. "Charging to 100 joules. CLEAR!" Button is pushed and Asuka's chest jumps, but heart is still in VTach. "Charge to 200. CLEAR!" Another shock goes through her heart as her chest jumps once again. She came back to normal sinus rhythm, but she must be observed. AED will be prepared if she goes to cardiac arrest once again. This time AI credit goes to @nicklasmuller Thank you very much for suggesting an edit.

[maleheartbeats]

I made my heart freak out again, driving it in a complete messy rhythm with vtach, pauses and skips. Felt kinda close to a cardiac arrest here lol 🫀🥵

Full video here!

🟢 https://linktr.ee/maleheartbeats 🟢

[moonsharky]

buddie & henren ∘⁠˚⁠˳⁠° 911 fox + dying parallels

[Image Description:

6 gifs alternating between two different scenes in two different episodes of 9-1-1. The left side of the gif set is of Henrietta “Hen” Wilson and Karen Wilson from season 6 episode 6. On the right side of the set, the contents are of Evan “Buck” Buckley and Eddie Diaz from season 6 episode 11.

Gif 1: The camera starts with a shot of the emergency entrance to the First Presbyterian Hospital, the lights from the ambulance reflecting off of the wall periodically. Doctors and nurses pour out of the entrance, running towards the reversed ambulance. The camera tilts downwards, showing the top of the ambulance as firefighters rush to open its doors.

Gif 2: The camera starts almost the exact same way; the emergency entrance being the first thing you see (at the same hospital), though its rainy and dark, making the emergency lights illuminate the entire area. A nurse rushes out of the doors towards the emergency vehicle, and the camera, like before, tilts downward to show the top edge of the ambulance as firefighters rush to open its doors.

Gif 3: Karen gets wheeled out of the ambulance on a gurney, an oxygen mask on her face, the camera view from above. It then changes to a shot from the direction of the loading bay doors, showing her getting rushed inside.

Gif 4: From the inside of the ambulance, we see Buck get wheeled out on a stretcher, Hen bagging him as Chimney does chest compressions. The shot changes to a birds-eye-view once more, Hen switching over the bagging to Bobby, and Chimney switching the CPR to Eddie.

Gif 5: In the back of the ambulance (before they get to the hospital - sorry, I had to gif it this way so the parallels were more obvious) Hen does compressions on her wife, trying to get her heart back into sinus rhythm. Bobby and Chimney continue to work on Karen in their own ways; Bobby trying to pump air into her lungs, and Chimney adding medication to her IV line.

Gif 6: As Buck gets run inside the ER, Eddie continues compressions on him, trying to get VTACH so they can shock him. Chimney jumps out of the ambulance and keeps his hand on Eddie’s back to help assist the gurney in the right place, Bobby bags Buck and pushes the gurney with his free hand, and Hen, goes to take over for Bobby.

/END ID]

[enriquemzn262]

medical case reports be like:

“The subject spent a day partially decapitated by a chainsaw. He made a full recovery after 2 weeks.”

“The subject was gently slapped, causing them to immediately enter pulseless vtach. “

Some people are just built different fam.

Dad, for example, was stabbed back in the 50’s, with one slash to the stomach so bad the attacker actually pulled out his intestines, and yet dad still had strength to fight him off long enough for his then wife to show up with a gun and drive them off.

It was raining hard that night so water started to get into the house through the open main doorway, and when dad fell after the adrenaline wore off, his intestines actually hit the ground and got soaked in the water, and even with all that plus the relatively primitive medicine of 1950’s Colombia, he managed to make a full recovery after three months.

[assassinregrets]

having one of those ~*sensory*~ days where a single piece of hair from my head poking out of my ponytail at just the right (wrong) angle has the ability to repeatedly terrify me to the point of vtach

[mcatmemoranda]

This is for sustained VTach:

Sustained monomorphic ventricular tachycardia (SMVT) is defined as a regular, wide (≥120 milliseconds) QRS complex tachycardia with uniform and stable QRS morphology at a rate of more than 100 beats per minute that lasts for 30 seconds or longer or causes hemodynamic collapse within 30 seconds.

●All patients with SMVT should have a brief immediate assessment of the symptoms, vital signs, and level of consciousness to determine if they are hemodynamically stable or unstable. Differentiation between a hemodynamically unstable versus stable patient depends upon hemodynamic compromise, such as hypotension, altered mental status, chest pain, or heart failure (HF).

●Patients with SMVT who are hemodynamically unstable and pulseless, or who become pulseless during the course of evaluation and treatment, should be managed according to standard advance cardiac life support (ACLS) resuscitation algorithms, with immediate high-energy countershock and cardiopulmonary resuscitation (CPR). Patients should initially be treated with a synchronized 120 to 200 joule shock from a biphasic defibrillator or a 360 joule shock from a monophasic defibrillator.

●For patients with wide complex tachycardia (WCT) who are hemodynamically unstable, but still responsive with a discernible blood pressure and pulse, we recommend urgent cardioversion (following administration of sedation) (Grade 1B).

●For patients with SMVT who are hemodynamically stable on presentation, after recording a 12-lead ECG we generally prefer to begin with an intravenous antiarrhythmic agent and reserve electrical cardioversion for refractory patients or for those who become unstable.

•If pharmacologic cardioversion is the chosen approach, we administer intravenous amiodarone, procainamide, or lidocaine.

•If electrical cardioversion with appropriate procedural sedation is the chosen approach, intravenous analgesics or sedatives should be cautiously administered if the blood pressure will tolerate their use. If the QRS complex and T wave can be distinguished, an attempt at synchronized cardioversion can be performed with a synchronized shock of 100 joules using either a biphasic or monophasic defibrillator.

●Treatment of underlying conditions associated with VT, such as myocardial ischemia, electrolyte disturbances, drug proarrhythmia, and HF, as well as decreasing the sympathetic facilitation of SMVT, are important components of the acute management of VT.

●Chronic therapy of patients with SMVT usually requires utilization of multiple therapeutic modalities, including the implantable cardioverter-defibrillator (ICD), antiarrhythmic drugs, radiofrequency catheter ablation, and/or arrhythmia surgery.

•In the absence of a clearly identifiable and reversible cause for SMVT, nearly all patients with a history of SMVT will be candidates for ICD insertion for secondary prevention of sudden cardiac death, unless the patient refuses or the risks of ICD insertion are felt to outweigh the potential benefits. (See 'ICD therapy' above.) •Nearly all patients who experience SMVT have an indication for therapy with a beta blocker, including patients with a prior myocardial infarction, patients with HF and reduced LV systolic function, etc. Beta blockers provide some level of protection against recurrent SMVT, primarily by reducing myocardial oxygen demand and blocking sympathetic input to the heart. (See 'Beta blockers' above.) •Antiarrhythmic drugs may also be used to improve quality of life in patients with frequent SMVT leading to ICD shocks, or in those patients who are not candidates for, or who decline, ICD implantation. Amiodarone has generally been the most effective antiarrhythmic drug for preventing ventricular arrhythmias (and associated ICD shocks). (See 'Antiarrhythmic drugs' above.) •For patients with recurrent SMVT resulting in ICD shocks despite treatment with an antiarrhythmic drug, we suggest radiofrequency ablation (RFA) rather than the addition of a second antiarrhythmic agent (Grade 2C). RFA is also an alternative to antiarrhythmic drugs as the initial therapy for SMVT. In addition, RFA, with or without antiarrhythmic drug therapy, is an option for patients with SMVT who are not candidates for or who refuse ICD implantation. (See 'Radiofrequency catheter ablation' above.)

[wandering-night19]

Thanks so much for the med things! I don’t mind the long-windedness, and in fact have some follow ups? I am not in the profession but I read a lot of articles and case studies.

Portable ECMOs do not seem to be meant for use in the field like that, correct? It is a major procedure…that is only meant for transport? And there is no way it would ever work that fast?

I can only imagine the frostbite situation, but yeah…that would have definitely been an issue. I am almost thankful they just ignored it rather than doing it badly.

Based on fanfic, I think I am in the minority, but I assumed that the ROSC would not occur until TK was in the hospital due to there being no shockable rhythm. With no rig and being far from the road, I figured they would do 5 min CPR/5 min carrying him out until they got to the road. I thought he would need to be warmer before

Wouldn’t they use an ECMO for a case as severe as his in hospital? Or do you assume that with COVID, etc. there was less likely to be rewarming in that manner?

Between the overdose, (supposed apparent) hypovolemic shock, and hypothermia/arrhythmia, how is his heart actually doing long-term? I love Paul but part of me was sad he got a heart condition storyline (which was also as wrong as it was right) when three-coma Strand is Right. There. It’s no wonder Carlos is his whole heart now…it is his only chance of staying alive.

Portable ECMOs do not seem to be meant for use in the field like that, correct? It is a major procedure…that is only meant for transport? And there is no way it would ever work that fast?

A portable ECMO is literally just for transport. And transporting an ECMO patient is a whole ordeal. When I did NICU transport it always required a nurse ride along and, sometimes, a doctor. Usually a teaching hospital would send an intern or resident so they could learn.

There is absolutely no medical professional I know that would start ECMO in the field like that even if by some miracle all the necessary supplies were there. It’s way too dangerous. Also, to start ECMO requires a surgeon. Not even the ER docs start it. They call for a consult to see if it’s appropriate and then discuss with the trauma surgeon.

Based on fanfic, I think I am in the minority, but I assumed that the ROSC would not occur until TK was in the hospital due to there being no shockable rhythm. With no rig and being far from the road, I figured they would do 5 min CPR/5 min carrying him out until they got to the road. I thought he would need to be warmer before

Okay I just went and watched the scene again, so I could try and guess at what happened. He’s in Vtach when they put him on the monitor (lies because there is no rhythm on the monitor!) which is a shockable rhythm. So good for them. But then they just stare at each other after. I’m assuming that means they got a pulse. But let’s break it down both ways…

The way an actual code works is that compressions are almost always happening. Once they started compressions he gets 2 minutes of it while they hook him to the monitor and start a line. Then pulse check for no more than 10 seconds which is when they’ll see the vtach rhythm. We’ve already established no pulse so this is pulseless vtach. (You can have vtach with a pulse.)

Then we would shock AND COMPRESSIONS WOULD RESUME. You do not stop compressions until the next pulse check!

I cannot for the life of me see what rhythm is supposed to be on that monitor while Tommy and Nancy are just staring at each other. I’m going to assume they’ve achieved ROSC because they don’t move to do anything else.

Let’s say the shock didn’t get a pulse back (asystole, which is possibly what they meant to convey with the tone they played.) One of them would resume compressions and the other would run to grab a back board and the Lucas.

This is a Lucas! Very handy. As long as it’s put on correctly.

TK would then be loaded up and ACLS would continue to be run until arrival at the hospital. ER would then take over resuscitation efforts. But downtime plays a big role in how long we run a code. Because he's young it would probably be worked for at least an hour.

Wouldn’t they use an ECMO for a case as severe as his in hospital? Or do you assume that with COVID, etc. there was less likely to be rewarming in that manner?

TK would probably be a good candidate for ECMO honestly. There's no other traumas to his body to be worried about. He should be able to start anticoagulation meds which are needed for ECMO. And he's young.

But again ECMO is a last ditch effort. All those other methods would also be happening. And then because he was a cardiac arrest they would talk about only warming him up to 36 C for what's known as a code cool. It would depend on cardiology and trauma docs. They like to argue about the science of it. There's a few studies and I honestly don't know if they would do the 24 hours of cooling post arrest.

Between the overdose, (supposed apparent) hypovolemic shock, and hypothermia/arrhythmia, how is his heart actually doing long-term? I love Paul but part of me was sad he got a heart condition storyline (which was also as wrong as it was right) when three-coma Strand is Right. There. It’s no wonder Carlos is his whole heart now…it is his only chance of staying alive.

Listen these people want me to believe that drug addict TK who was once found with a needle in his arm by his mother in a drug house somehow made it through those years without contracting anything? You're telling me he doesn't have Hep A, B, or C? He's not HIV+? He didn't get endocarditis? Or MRSA? Or osteomyelitis? Or a damn abscess?

He'd be the luckiest human on earth.

As for his heart a cardiologist would literally cry if they read his health history. I know because I presented TK as a hypothetical case during one of our medical minutes (it's a fun thing we do when there's down time where we run through how to treat something). Our on call cardiologist that was down charting said he'd want TK to have an ECHO and EKG once a month for an entire year following the debacle. So like I have no idea how TK is just all fine and walking around.

[diazly]

just a warning bc im annoying. if they shock him when hes asystole you will be hearing from me. VFIB AND PULSELESS VTACH ARE THE ONLY SHOCKABLE RHYTHMS

[redbleedingrose]

Your daily update from me by me:

I am in love with @augustinerose

This is actually a horrific depiction of what an EKG would look like. Maybe looks like VTach but hey! I suck at EKGs anyway 🤗😚🤭

[kampflesben]

my patient is stuck in Vtach but since her frequency is below 150 the doctor says we'll tolerate it, but now I'm stuck at the telemetry monitors silencing the alarm every minute 😭 this is gonna be my entire night..

[melancholicvnt]

hey um. PSA for anyone who does DPH: combining DPH and alcohol can cause vtach and torsade de pointes (i.e. Bad Heart Things) when combined. there are a bunch of case studies/medical papers done on this. so don’t combine ‘em!

[heartbeater168]

Have you ever had runs of vtach?

Nope, just regular old tach.