Ventricular Tachycardia (VT) in ECG

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about the shockable rhythm of ventricular tachycardia (and ECG).

In today’s micro-lecture, we’re going to talk about the shockable rhythm of ventricular tachycardia. Now when you’re trying to determine if a rhythm is shockable or non-shockable, the good news is you only have to remember there’s only two shockable rhythms: ventricular fibrillation and ventricular tachycardia. This is what ventricular tachycardia looks like. The non-shockable rhythms are asystole and pulseless electrical activity. And we have a video about those, too. So when you see a patient who’s got this rhythm here, ventricular tachycardia, it’s beating so fast that the heart isn’t able to perfuse blood around the body. So what this patient needs is a direct shock to the sinoatrial node to try and reset it. In other words, this rhythm is treated in exactly the same way as ventricular fibrillation and there’s no difference between the two.

So, if you were to take a look at this image here. It’s very difficult to even begin to try and use a staged approach to try and interpret what’s happening. So you need to try and train your mind to be able to recognise the morphology of ventricular tachycardia just by looking at it. So what I would recommend you guys do is to get into the habit of looking at all the different types of morphology of ventricular tachycardia, and just learning what they look like off by heart. So, let’s have a look at a couple together. So the issue with ventricular tachycardia is that the heart is beating so fast. In other words, the ventricle’s moving so fast. That’s the actual mechanisms that makes ventricular tachycardia the shockable rhythm. And regardless of the type of morphology, look what’s happening. It’s just so fast. There’s nothing else there, you can’t see a P wave, you can’t see a T wave. This patient really does need a large shock quickly to try and recover it.

These are all ventricular tachycardias, guys. They all need defibrillation. So as you can see, they’re very broad. They’re very wide. They’re fast moving, and of course once you’ve the AED out, the AED will actually recognise this as a shockable rhythm and it will deliver the shock. However, as a paramedic, we don’t use AEDs so much at the moment. In fact, what we do do is we recognise the morphology and we deliver the shock ourselves because that way, we can act much faster and we can actually give it much calmer, controlled, therapeutic delivery of that shock, rather than just giving whatever the machine wants to give. So in a nutshell, guys, that’s ventricular tachycardia. So shockable rhythm is the cardiac arrest rhythm and you need to take some time to look at all the different morphologies if you’re going to be able to look at it and just say, “That’s beating,” without any thought.

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