How does ventricular tachycardia appear on telemetry, and what immediate action depends on pulse?

How does ventricular tachycardia appear on telemetry, and what immediate action depends on pulse?

• A. Wide complex tachycardia ≥120 bpm; if no pulse, start CPR and defibrillate; if a pulse is present, consider synchronized cardioversion.
• B. Narrow complex tachycardia; administer adenosine.
• C. Ventricular fibrillation; immediate defibrillation.
• D. Asystole; CPR only.

Answer: (A)

Ventricular tachycardia on telemetry appears as a fast rhythm with wide QRS complexes, typically at or above about 120 beats per minute. The wide QRS shows the rhythm originates in the ventricles rather than the atria, which is the hallmark that it’s VT rather than a supraventricular tachycardia with a fast rate. What you do next depends on whether the patient has a pulse. If there is no pulse, treat this as cardiac arrest: start CPR and defibrillate as soon as possible. If there is a pulse, the goal is to restore a stable rhythm while preserving perfusion, so you would perform synchronized cardioversion (delivering a synchronized shock to terminate the VT while maintaining coordination with the heartbeat). Why this fits better than other choices: narrow complex tachycardias imply a supraventricular origin and are typically managed with measures like adenosine, not VT. Ventricular fibrillation and asystole are distinct arrest rhythms with different immediate actions (defibrillate for VF, CPR for asystole) and are not described by VT’s appearance on telemetry.

Ventricular tachycardia on telemetry appears as a fast rhythm with wide QRS complexes, typically at or above about 120 beats per minute. The wide QRS shows the rhythm originates in the ventricles rather than the atria, which is the hallmark that it’s VT rather than a supraventricular tachycardia with a fast rate.

What you do next depends on whether the patient has a pulse. If there is no pulse, treat this as cardiac arrest: start CPR and defibrillate as soon as possible. If there is a pulse, the goal is to restore a stable rhythm while preserving perfusion, so you would perform synchronized cardioversion (delivering a synchronized shock to terminate the VT while maintaining coordination with the heartbeat).

Why this fits better than other choices: narrow complex tachycardias imply a supraventricular origin and are typically managed with measures like adenosine, not VT. Ventricular fibrillation and asystole are distinct arrest rhythms with different immediate actions (defibrillate for VF, CPR for asystole) and are not described by VT’s appearance on telemetry.