A nurse is caring for a client who is in pulseless ventricular tachycardia (V-Tach). The nurse recognizes the need for which priority intervention?
A.
Synchronized Cardioversion
B.
Repeat electrocardiogram (ECG)
C.
Assessment of blood pressure
D.
Immediate Defibrillation
The Correct Answer and Explanation is:
Correct Answer: D. Immediate Defibrillation
Pulseless ventricular tachycardia (V-Tach) is a life-threatening cardiac arrhythmia characterized by rapid heartbeats originating from the ventricles. It is a type of shockable rhythm, meaning that the most critical and immediate intervention is defibrillation.
Explanation:
Understanding Ventricular Tachycardia (V-Tach): Ventricular tachycardia occurs when abnormal electrical signals in the heart’s ventricles cause the heart to beat too quickly. In pulseless V-Tach, the heart is not effectively pumping blood, leading to a lack of pulse, severe hypotension, and potential cardiac arrest. The rapid ventricular rate impairs the heart’s ability to fill properly during diastole, which severely decreases cardiac output and blood flow to vital organs.
Why Immediate Defibrillation? The primary goal in treating pulseless V-Tach is to restore an effective rhythm that can sustain circulation. Defibrillation delivers a high-energy electrical shock that can depolarize the heart muscles simultaneously, interrupting the chaotic electrical activity and allowing the heart’s normal pacemaker (the sinoatrial node) to re-establish an effective rhythm. Immediate defibrillation is crucial because the longer the heart remains in pulseless V-Tach, the lower the chances of survival due to the rapid onset of organ ischemia and eventual irreversible damage.
Why Not Other Options?
- A. Synchronized Cardioversion: Synchronized cardioversion is typically used for unstable arrhythmias that still have a pulse, such as atrial fibrillation or V-Tach with a pulse. It delivers a shock that is timed with the heart’s electrical activity. However, in pulseless V-Tach, the priority is immediate defibrillation rather than synchronized cardioversion.
- B. Repeat Electrocardiogram (ECG): While an ECG can provide more information about the rhythm, it is not the immediate priority in pulseless V-Tach. The focus should be on rapid intervention to restore a perfusing rhythm.
- C. Assessment of Blood Pressure: Although assessing blood pressure is important, it is not the priority in a pulseless condition. Pulseless V-Tach indicates there is no effective cardiac output, rendering blood pressure assessment secondary to defibrillation.
Conclusion: In summary, the immediate and life-saving intervention for a client in pulseless ventricular tachycardia is defibrillation. The other options, while important in different contexts, do not address the urgent need to correct the life-threatening arrhythmia and restore effective cardiac function. Therefore, prompt defibrillation is the key to increasing the likelihood of survival in this scenario.