Monomorphic V-Tach and Low Potassium

[bert911]

If you responded to a person who is sick at home and that patient has not been taking their K-Dur medicine for a few days and you find your CHF patient, who had been prescribed Labetalol, Lasix and K-dur, and showed monomorphic V-tach on the monitor, would you synchonize cardiovert the patient first if he was hemodynamically unstable knowing that he is low on potassium which might convert your patient into unwanted and nonperfusing rhythm?  Would we harm the patient if we shock them?

Or

Would you try to administer amiodarone 150 mg mixed in 50cc bag normal saline over 10 minute first?

[Momto3]

Thanks for being so diligent!  All of us who could be your "what if" patient are grateful.

[bert911]

No its not a test question. It's a what if question.

I came across this scenario and I just want to see other opinions.

Bromley thanks for all the great replies.

Lidocaine is no longer used in Las Vegas.

According to our protocol we shock with sedation(etomidate), then give cordarone/amiodaron over ten minutes, then cycle starts over again about three times with a final shock.

I was just wondering if the sodium/potassium pump of the heart is not working properly, then shocking would not help convert the rhythm except for maybe into asystole.  I have come to a conclussion not to shock if I ever come across a patient like this.  I would call the medical direction for further advice.  Thanks all for the great comments.  I will try to post the question in the hrt rhythm expert forum.

[Bromley]

Yes you may be right about that. And I think this question may describe an unusual situation or application of the concepts. It is one thing to answer the question wrong on the exam; another to have to make a hard decision in real life without supportive, expert guidance. I wonder which it is here.

According to wiki, a person in hemodynamically unstable VT should be cardioverted before receiving amiodarone. This question suggests that the action may contradict another protocol which might say that a person low on potasium and in VT should not be cardioverted. It does look like a test question.

Hopefully though we could comprehend the potential emotional impact of being in a situation like this without answers. Of course this forum is intended for suffers of abnormal heart beats, not for instructing medical people, so the question may still not be the best fit for the community forum? Hmmm.

[wmac]

I thought lidocaine was first line treatment???

[Bromley]

Actually, if you had to make this decision, I suppose it must not have been very easy, especially if you had to make it without expert advice, or if the outcome was unfavorable.

On second thought I dont think my previous statement regarding wiki was a good one. You can forget about that please.

[Bromley]

Dude the answer is in Wikipedia. According to Wiki you would cardiovert. People with hemodynamically unstable VT should not receive amiodarone.

HOWEVER,   I have no way of knowing if this is correct (I am not a medical professional).  If you run into this situation, I suggest a phone call to the doc.  You can also post your question on the heart rhythm expert forum. That one has a doctor to answer the questions.

regards, Bromley.

[wmac]

Are you a med student looking for quick answers or has this happened to you or someone you know? just curious.

[Momto3]

Is this a test question?