That’s not always true. I’m a flight paramedic and our protocols read Adenosine first and if that doesn’t work then Amio. It’s because it’s monomorphic and opposed to polymorphic
Check the ACLS algorithms. I was also taught amio for stable v tach and basically was taught to give it, not just consider. But, the ACLS lists treatment for regular, wide complex tachy(stable) as considering adenosine(if regular and monomorphic) or amio.
Both... Adenosine 6mg/12mg then if that isnt sucessful then move to 150mg over 10mins... Adenosine is much faster to see if it works or not, vs waiting 10 mins. It could be a rhythm that is only wide due to other complications like a bundle branch etc.
1: Vagal maneuvers are for narrow complex tachs; you start with adenosine with wide complex tachycardias if they’re stable-and adenosine is not the treatment but its diagnostic; otherwise, you would administer amiodarone 150 mg over 10 mins
I see a lot of comments down here go against with Adenosine for Regular Monomorphic VT. It is clearly stated in ACLS Adult Tachycardia with a Pulse algorithm that "Consider Adenosine IV" in case of Regular Wide QRS tachy. If the rhythm changed after Adenosine administered, it means the rhythm is at atrial origin and SVT with aberrancy. Also, believe that Vagal maneuver is not mentioned for Stable VT at all by ALCS.
You can use Adenosine diagnostically if you SUSPECT SVT with aberrancy. That is clearly V-tach. Adenosine is not first line. That isn't what SVT with aberrancy looks like. Vagal and adenosine were not indicated on that strip.
National registry goes by the 2015 AHA ACLS which recommends Adenosine first for stable V-Tach. Possibility of it being a SVT with aberrancy (BBB) and not true V-Tach.
@@jm4472 No, AMI 150 VTACH w/pulse. Plus, your not vagal VTACH. I think he got it messed up with SVT. SVT is Adenosine 6mg rapid push followed by flush, then 12mg. Try vagal with SVT. Don't know what AHA your reading out of.....
@@jm4472 Page 13 of AHA Emergency Cardiovascular Care states AMI IV dose: 1st dose 150mg over 10 min. Repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours. Stable WIDE tachycardia. That is what they are teaching first line NREMT. 2020 ACLS protocols it says "consider" adenosine. Key word "consider"
Late reply, but I see a lot of comments saying not to push adenosine for mono v-tach stable. According to ACLS protocol stable mono vtach falls under the treatment of 2 doses of adenosine (6mg and then 12mg after 2mins n/c) then followed by 150mg of Ami.
Check the ACLS algorithms for tachycardia with a pulse. A wide complex, monomorphic and regular tachycardia can be treated with adenosine. Those three conditions must be met however.
@@TheAncientScholar Adenosine is used to distinguish SVT from VT, when appropriate. It is not the first line drug given for VT nor is it the treatment of. And ACLS does not recommend adenosine for wide complex rhythms, thats bullshit and you know it.
@@dukecornfield1848 So I'm staring at the ACLS pamphlet with the tachycardia algorithm on it and @TheAncientScholar is correct. Granted, you have a point about how to treat Vtach appropriately but again, this is more or less showing you know the algorithm to the proctors during the psychomotor test. @TheAncientScholar even says that in his Part3 video prior to this if you go back look at it.
You also should most definitely check your protocols as well.. where I practice adenosine is first considered with wide regular QRS and then lido or amio.
Confused on first one. Why Vagal for wide qrs tachy? Should that be straight to adenosine then if refractory treat underlying cause, cardiovert then amio per als algorithm?
ok heres my take and Ive been a medic almost 30 years still learning. just reviewed 2020 ACLS protocols it says "consider" adenosine and it also says consider expert consultation. because I hate to screw around, waste time, fill patients full of different drugs Ill call the Dr. give a quick run down, and hopefully give the right drug. Ive seen ami work more times that adenosine so theres that, doesnt mean its my go to just means I want to coorect the Vtach before Im coding someone so I lean towards ami
Rhythm #1 is a wide complex tachycardia. Pulses or no pulses although the scenario states hemodynamically stable. 150 mg Amiodarone in 100 ml ofD5 over 10 minutes.
Thank you! for this video. I realized what I did wrong in this station last saturday. I was trying to Identify a rhythm in the 12 lead ecg strip and completely missed the stemi portion.
@@ccarlton5830 that has nothing to do with alleviating my tension lol. I could care less that he mispoke about stable wide complex tach. The point is, he gave a clear layout of what to expect
@@ccarlton5830 if I'm not mistaken, for a diagnostic measure, it can be appropriate. Actually as I'm looking at the 2020 ACLS book that's exactly what it says lol for monomorphic, bullet point above an antiarrhythmic infusion like Amiodarone
Why in the world would you vagal and give adenosine to a PT in V-TACH!!! What! 😱 you give adenosine to a PT in SVT NOT V-TACH! You give AMEO to a patient in V-tach and you don’t vagal them either unless they are in SVT .
Bryan, have you seen the 2020 AHA ACLS algorithm for tachycardia with a pulse? Adenosine is acceptable for a stable wide complex tachycardia as long as it is regular and monomorphic. There are three antiarrhythmic agents that can be considered for such a tachycardia and include amiodarone, procainamide or sotalol. This is of course, in the context of a situation that doesn’t call for specialized interventions such as intralipid for local anesthetic toxicity or sodium bicarbonate for wide complex tachycardia in the setting of TCA overdose.
Amio 150mg over 10min for stable v tach. Not adenosine
If your gonna make a video make the drugs correct!!
That’s not always true. I’m a flight paramedic and our protocols read Adenosine first and if that doesn’t work then Amio. It’s because it’s monomorphic and opposed to polymorphic
Check the ACLS algorithms. I was also taught amio for stable v tach and basically was taught to give it, not just consider. But, the ACLS lists treatment for regular, wide complex tachy(stable) as considering adenosine(if regular and monomorphic) or amio.
@@terrymaxwell2203 Adenosine is indicated for SVT + Regular MONO WCT, If that doesn't work then Amio, protocols may differ.
Both... Adenosine 6mg/12mg then if that isnt sucessful then move to 150mg over 10mins... Adenosine is much faster to see if it works or not, vs waiting 10 mins. It could be a rhythm that is only wide due to other complications like a bundle branch etc.
1: Vagal maneuvers are for narrow complex tachs; you start with adenosine with wide complex tachycardias if they’re stable-and adenosine is not the treatment but its diagnostic; otherwise, you would administer amiodarone 150 mg over 10 mins
Sorry but that´s just not correct.
I see a lot of comments down here go against with Adenosine for Regular Monomorphic VT. It is clearly stated in ACLS Adult Tachycardia with a Pulse algorithm that "Consider Adenosine IV" in case of Regular Wide QRS tachy.
If the rhythm changed after Adenosine administered, it means the rhythm is at atrial origin and SVT with aberrancy.
Also, believe that Vagal maneuver is not mentioned for Stable VT at all by ALCS.
Nam Nguyễn That’s right, it’s there, but the vagal maneuvers are not.
You can use Adenosine diagnostically if you SUSPECT SVT with aberrancy. That is clearly V-tach. Adenosine is not first line. That isn't what SVT with aberrancy looks like. Vagal and adenosine were not indicated on that strip.
I almost spit out my coffee when he said TO GIVE adenosine for V-tach. 150mg of Amiodarone pushed over 10min.
National registry goes by the 2015 AHA ACLS which recommends Adenosine first for stable V-Tach. Possibility of it being a SVT with aberrancy (BBB) and not true V-Tach.
@@jm4472 Yes, it was changed.
@@jm4472 No, AMI 150 VTACH w/pulse. Plus, your not vagal VTACH. I think he got it messed up with SVT. SVT is Adenosine 6mg rapid push followed by flush, then 12mg. Try vagal with SVT. Don't know what AHA your reading out of.....
@@ccarlton5830 2015 AHA guidelines. Read it again buddy
@@jm4472 Page 13 of AHA Emergency Cardiovascular Care states AMI IV dose: 1st dose 150mg over 10 min. Repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours. Stable WIDE tachycardia. That is what they are teaching first line NREMT. 2020 ACLS protocols it says "consider" adenosine. Key word "consider"
Late reply, but I see a lot of comments saying not to push adenosine for mono v-tach stable. According to ACLS protocol stable mono vtach falls under the treatment of 2 doses of adenosine (6mg and then 12mg after 2mins n/c) then followed by 150mg of Ami.
For the second rhythm you can also say it is a second degree type two heartblock with PEA
Great VIDEO THANK YOU
Why Adenosine for the patient with WIDE COMPLEX V-TACH? The book and ACLS say AMIODARONE or PROCAINAMIDE.
Check the ACLS algorithms for tachycardia with a pulse. A wide complex, monomorphic and regular tachycardia can be treated with adenosine. Those three conditions must be met however.
@@TheAncientScholar, You are right. Thank you for responding back.Great video...
@@TheAncientScholar Adenosine is used to distinguish SVT from VT, when appropriate. It is not the first line drug given for VT nor is it the treatment of. And ACLS does not recommend adenosine for wide complex rhythms, thats bullshit and you know it.
@@dukecornfield1848 So I'm staring at the ACLS pamphlet with the tachycardia algorithm on it and @TheAncientScholar is correct. Granted, you have a point about how to treat Vtach appropriately but again, this is more or less showing you know the algorithm to the proctors during the psychomotor test. @TheAncientScholar even says that in his Part3 video prior to this if you go back look at it.
You also should most definitely check your protocols as well.. where I practice adenosine is first considered with wide regular QRS and then lido or amio.
Great video, YES, more videos with more rhythms would be greatly appreciated!
Great video. Demystifies that scary station a bit. In the first scenario, when would you move on to amiodarone drip?
Great presentation, thanks! 👍👍
Confused on first one. Why Vagal for wide qrs tachy? Should that be straight to adenosine then if refractory treat underlying cause, cardiovert then amio per als algorithm?
thanks would love some more videos on other psychomotor skills
ok heres my take and Ive been a medic almost 30 years still learning. just reviewed 2020 ACLS protocols it says "consider" adenosine and it also says consider expert consultation. because I hate to screw around, waste time, fill patients full of different drugs Ill call the Dr. give a quick run down, and hopefully give the right drug. Ive seen ami work more times that adenosine so theres that, doesnt mean its my go to just means I want to coorect the Vtach before Im coding someone so I lean towards ami
Rhythm #1 is a wide complex tachycardia. Pulses or no pulses although the scenario states hemodynamically stable. 150 mg Amiodarone in 100 ml ofD5 over 10 minutes.
Adenosine is acceptable in wide complex, regular tachycardias per AHA ACLS guidelines.
Thank you! for this video. I realized what I did wrong in this station last saturday. I was trying to Identify a rhythm in the 12 lead ecg strip and completely missed the stemi portion.
Very helpful video! Would I have been wrong to treat the A-Fib with Cardizem and still address the stroke symptoms?
I would prioritize the stroke and treat with a Calcium Channel block en route!
The rate isn’t fast enough for cardizem. Cardizem is for RVR
@@mudbuggie90 I’m so glad that I know this now 😊
wait you called a code stroke purely based on a-fib?
The stroke concern was due to the sudden onset neurological deficits. Plus, the history of a-fib increases stroke risk.
Thanks man, that made me alot less nervous
Nope, because hes giving wrong meds to the wrong rhythm
@@ccarlton5830 that has nothing to do with alleviating my tension lol. I could care less that he mispoke about stable wide complex tach. The point is, he gave a clear layout of what to expect
@@dylanfitch2997 Your giving the wrong information to people learning static cardiology. Period. First line drug, AMI.
He is... not you lol
@@ccarlton5830 if I'm not mistaken, for a diagnostic measure, it can be appropriate. Actually as I'm looking at the 2020 ACLS book that's exactly what it says lol for monomorphic, bullet point above an antiarrhythmic infusion like Amiodarone
i love how this guy is talking so calm like he knows what to do lol thats how to do it!
Most interventions are incorrect. And I dont understand why people run trauma codes-you’re just going to kill the pt faster…
It’s amiodarone, not adenosine. And are you really stuck in the times where everybody gets O2 no matter what?
Tis the season...
Why in the world would you vagal and give adenosine to a PT in V-TACH!!! What! 😱 you give adenosine to a PT in SVT NOT V-TACH! You give AMEO to a patient in V-tach and you don’t vagal them either unless they are in SVT .
Bryan, have you seen the 2020 AHA ACLS algorithm for tachycardia with a pulse? Adenosine is acceptable for a stable wide complex tachycardia as long as it is regular and monomorphic. There are three antiarrhythmic agents that can be considered for such a tachycardia and include amiodarone, procainamide or sotalol. This is of course, in the context of a situation that doesn’t call for specialized interventions such as intralipid for local anesthetic toxicity or sodium bicarbonate for wide complex tachycardia in the setting of TCA overdose.