For Torsades, our book (Paramedic Care: Principles & Practice (Pearson)) states "attempting treatment of torsades with antiarrhythmics usually used for the treatment of ventricular tachycardia can have disastrous consequences". This book also recommends overdrive pacing instead of defibrilation.
This is pulseless torsades which would be treated as any other shockable polymorphic rhythm as per ACLS (defibrillate). In cardiac arrest mag sulfate and/or overdrive pacing isn’t part of the algorithm. However, if we saw this patient with a pulse we would approach treatment differently. I would refer to ACLS over the paramedic care book because NREMT uses ACLS as their standard. I have seen overdrive pacing as a possible treatment but ACLS also says there is limited evidence of how effective it is. I have never seen anyone do it. Historically ventricular tachycardia with a pulse would be cardioverted. The problem with polymorphic vtach was difficulty syncing for cardioversion. The recommendation was to defibrillate if unable to sync for cardioversion. But things do change, new information is always coming out, and I’m not always right so it could be one of those. For this instance though I think the most important thing is that pulseless torsades (cardiac arrest) gets treated the same as any pulseless polymorphic vtach with defib. You can give mag. Amiodarone and procainamide are no good but lidocaine is the preferred anti-arrhythmic drug for torsades. Sorry for the delay. Hope that explained it better.
NREMT goes by ACLS guidelines. The most recent acls guidelines say to check with your manufacturers guidelines to maximize first shock success. I used to use a lifepak at my old job and our medical director wanted us to use 200, 300, 360 for defib. Now I use a zoll and they recommend going right to the max dose. So I would say go with what your program tells you because it’s not really clear and I’m not sure if there is really a right answer.
A fluid bolus is a rapid infusion of fluids over a short period of time. It would be like starting an IV, hanging a 500 mL bag of normal saline solution, and letting it run wide open to administer fluids rapidly until you reach 250 mL or 500 mL (depending on your goal).
@@medictestsecrets Is this part of the ACLS algorithm? I'm asking bc I have my NREMT psychomotor exam coming up and was worried about adding a fluid bolus without confirming through 12 lead it was not a right sided infarct.
@@davidelliottsr.9391 So when talking about cardiac arrest rhythms and resuscitation there are two reasons why we administer fluids. They aren't stated directly in the ACLS algorithm in so many words. However, number 1 is medication delivery. When you obtain IV/IO access with a 500 mL bag of NSS running you are giving yourself an easy route for medication delivery. Number two is when working a cardiac arrest as we are performing resuscitation we need to be considering reversible causes. Hypovolemia is a common cause of cardiac arrest. When you get IV/IO access and start to administer fluids you check that box for treating reversible causes. If you don't feel comfortable using "fluid bolus" you can say "I'm going to obtain IV/IO access and administer a 500 mL bag of normal saline solution". Or you can leave it out. None of this stuff is an exact science. When testing they want to see that you understand what is going on, that you know your algorithms, that you're thinking ahead and able to think critically, and that you are able to appropriately treat your patient. I created this to be flexible and be a framework for you to build off. Use from it what you find useful. The treatment algorithms I have in the video I memorized and regurgitated in my NREMT exam and passed. Good luck!
This literally just saved me. I made sure to follow and got the study help stuff for only $19!!! I have already told the rest of my class about this.
That’s great to hear! Glad you found it helpful! Thanks for your support.
Very good video, one of the best ive seen in my 4 years
great info for those working their way through medical raining.!👍
That’s the mission!
For Torsades, our book (Paramedic Care: Principles & Practice (Pearson)) states "attempting treatment of torsades with antiarrhythmics usually used for the
treatment of ventricular tachycardia can have disastrous consequences". This book also recommends overdrive pacing instead of defibrilation.
This is pulseless torsades which would be treated as any other shockable polymorphic rhythm as per ACLS (defibrillate). In cardiac arrest mag sulfate and/or overdrive pacing isn’t part of the algorithm. However, if we saw this patient with a pulse we would approach treatment differently.
I would refer to ACLS over the paramedic care book because NREMT uses ACLS as their standard. I have seen overdrive pacing as a possible treatment but ACLS also says there is limited evidence of how effective it is. I have never seen anyone do it.
Historically ventricular tachycardia with a pulse would be cardioverted. The problem with polymorphic vtach was difficulty syncing for cardioversion. The recommendation was to defibrillate if unable to sync for cardioversion.
But things do change, new information is always coming out, and I’m not always right so it could be one of those.
For this instance though I think the most important thing is that pulseless torsades (cardiac arrest) gets treated the same as any pulseless polymorphic vtach with defib. You can give mag. Amiodarone and procainamide are no good but lidocaine is the preferred anti-arrhythmic drug for torsades. Sorry for the delay. Hope that explained it better.
Thanks
Is there a way to get the study flashcards? The link is inoperable.
For the actual test you just have to name the rhythm right? Not all the identification points?
Correct for testing you need to identify the rhythm and the appropriate treatment of the rhythm. Good luck!
Is NREMT still teaching stacked shocks vs highest available energy?
NREMT goes by ACLS guidelines. The most recent acls guidelines say to check with your manufacturers guidelines to maximize first shock success. I used to use a lifepak at my old job and our medical director wanted us to use 200, 300, 360 for defib. Now I use a zoll and they recommend going right to the max dose. So I would say go with what your program tells you because it’s not really clear and I’m not sure if there is really a right answer.
What do you mean by administrator a fluid bolus?
A fluid bolus is a rapid infusion of fluids over a short period of time. It would be like starting an IV, hanging a 500 mL bag of normal saline solution, and letting it run wide open to administer fluids rapidly until you reach 250 mL or 500 mL (depending on your goal).
@@medictestsecrets Is this part of the ACLS algorithm? I'm asking bc I have my NREMT psychomotor exam coming up and was worried about adding a fluid bolus without confirming through 12 lead it was not a right sided infarct.
@@davidelliottsr.9391 So when talking about cardiac arrest rhythms and resuscitation there are two reasons why we administer fluids. They aren't stated directly in the ACLS algorithm in so many words. However, number 1 is medication delivery. When you obtain IV/IO access with a 500 mL bag of NSS running you are giving yourself an easy route for medication delivery. Number two is when working a cardiac arrest as we are performing resuscitation we need to be considering reversible causes. Hypovolemia is a common cause of cardiac arrest. When you get IV/IO access and start to administer fluids you check that box for treating reversible causes. If you don't feel comfortable using "fluid bolus" you can say "I'm going to obtain IV/IO access and administer a 500 mL bag of normal saline solution". Or you can leave it out. None of this stuff is an exact science. When testing they want to see that you understand what is going on, that you know your algorithms, that you're thinking ahead and able to think critically, and that you are able to appropriately treat your patient. I created this to be flexible and be a framework for you to build off. Use from it what you find useful. The treatment algorithms I have in the video I memorized and regurgitated in my NREMT exam and passed. Good luck!
@@medictestsecrets Thanks so much!