Question: While taking our manual defibrillation training on the new LP15 we were told "if the rhythm is fast and wide, shock it" obviously the PT is pulseless as well. We were told the "fast" value is greater than 120. We were never told the "wide" value. I have asked both ACP and PCP paramedics and have gotten responses of 0.12, 0.16, and 0.20. So, could you tell me what SWORBHP considers the correct value for "fast"? Thanks!
Great question. If a patient has suffered a cardiac arrest, and your monitor demonstrates an organized wide complex tachycardia such as you are describing, then administering a defibrillation is indicated.
The 2010 AHA Guideline (Neumar et al Part 8: Adult Advanced Cardiovascular Life Support Circulation 2010) states that:
Wide-complex tachycardias are defined as those with a QRS greater or equal to 0.12 second.
A pulseless patient with a wide complex (QRS greater or equal to 0.12 seconds) rhythm that is tachycardic (greater or equal to 100) requires defibrillation. The majority of pulseless VTs will present with rates >120, however there are instances where the rate can be 100-120. The most important thing to consider here is to not treat VT as PEA given the higher chance of survival from "shockable" rhythms.