Pulseless Ventricular Tachycardia

Ventricular Tachycardia
Ventricular Tachycardia

The pulseless ventricular tachycardia rhythm is primarily identified by several criteria. First, the rate is usually greater than 180 beats per minute and the rhythm generally has a very wide QRS complex. Second, the patient will be pulseless and third, the rhythm originates in the ventricles. This is in contrast to other types of tachycardias which have origination above the ventricular tissue (in the atria). Not all ventricular tachycardias are pulseless and therefore, pulselessness must be established prior to beginning an algorithm. This is accomplished simply by checking a carotid or femoral pulse. Pulselessness with a tachyarrhythmia occurs because the ventricles are not effectively moving blood out of the heart and there is therefor no cardiac output. Many tachyarrhythmias of a rate >150 will deteriorate into pulselessness if timely treatment is not given. Pulseless ventricular tachycardia is treated using the left branch of the puslesless arrest arrest algorithm.

Ventricular Fibrillation

Ventricular Fibrillation
Ventricular Fibrillation

Ventricular fibrillation or VF occurs when there are uncoordinated contractions within the ventricles of the heart. The primary cause of VF is hypoxia (lack of oxygen) to the heart muscle which causes hyperirritability in the cardiac muscle tissue. As a result, multiple muscles cells within the ventricles simultaneously fire as pacemakers causing a quivering or fibrillation that is ineffective for adequate cardiac output.
Ventricular Fibrillation ECG Tracing
Ventricular Fibrillation ECG Tracing

The two images above show what ventricular fibrillation will look like on a EKG rhythm strip. VF can rapidly lead to heart muscle ischemia and there is a high likelihood that it will deteriorate into asystole. Ventricular fibrillation is treated using the left branch of the puslesless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.

Pulseless Arrest Algorithm Diagram.

Ventricular fibrillation is always pulseless and must be confirmed by EKG or defibrillator monitor. Defibrillation is the treatment of choice and should occur as soon as possible.

Pulseless Electrical Activity (PEA) Rhythm

PEA rhythm occurs when any heart rhythm that is observed on the electrocardiogram (ECG) does not produce a pulse. PEA can come in many different forms. Sinus Rhythm, tachycardia, and bradycardia can all be seen with PEA. Performing a pulse check after a rhythm/monitor check will ensure that you identify PEA in every situation. Pulseless electrical activity usually has an underlying treatable cause. The most common cause in emergency situations is hypovolemia. PEA is treated by assessing and correcting the underlying cause. These causes can be summed up in the 6 H’s and 6 T’s of ACLS. Use the link to review the H’s and T’s. When an underlying cause for pulseless electrical activity cannot be determined, PEA should be treated in the same fashion as asystole. Pulseless electrical activity is treated using the right branch of the puslesless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.

Pulseless Arrest Algorithm Diagram.
Pop-Quiz:
Question #1: If you saw the rhythm below after defibrillation, how would you determine if it is pulseless electrical activity?

EKG of Sinus Rhythm with PVC's
EKG of Sinus Rhythm with PVC's


click here for answer



Question #2: What is the most common cause of PEA?

click here for answer