shockable rhythms
Introduction Shockable Rhythms
When an individual suffers from a sudden cardiac arrest, knowing how to use a defibrillator is a lifesaving skill. And the cornerstone of using one effectively is the ability to recognize shockable rhythms irregular heartbeats that can be treated with an electric shock, or defibrillation.
In certain cases, these rhythms can be seen on an electrocardiogram (ECG), which is used to monitor patients in intensive care and in emergency situations. For those trained in ECG interpretation, recognizing shockable rhythms becomes second nature.
That said, even if you don’t have a background in medical diagnosis and treatment, you can still learn how to spot the signs of shockable rhythms on an ECG machine. In this article we’ll walk you through the basics of interpreting ECGs so that you too can acquire this vital knowledge. Let’s get started.
What Are Shockable Rhythms?
In the medical field of cardiology, shockable rhythms are a type of abnormal heart rhythms. This refers to any rhythm that can be treated with an electrical shock more commonly referred to as defibrillation to reset the heart’s normal rhythm.
Shockable rhythms fall into two categories ventricular fibrillation and ventricular tachycardia (or VT). Ventricular fibrillation is an irregular, disorganized heartbeat characterized by complete loss of both electrical and mechanical activity in the ventricles, while ventricular tachycardia is a rapid heartbeat, caused by irregular electrical activity in the ventricles. Both of these require immediate treatment with a defibrillator.
The key takeaway here is that shockable rhythms must be treated quickly to ensure the best possible outcomes and prevent further damage to the heart or other organs. If you find yourself managing someone who has suffered a cardiac arrest, it’s important to recognize these rhythms and take immediate action if necessary.
Ventricular Tachycardia (VT) is a shockable rhythm that falls under the category of ventricular arrhythmia and is characterized by three or more consecutive beats with a rate of 100 bpm. It can cause palpitations, lightheadedness, chest discomfort and possible syncope (fainting).
VT can be further classified as monomorphic VT or polymorphic VT based on its characteristics. Monomorphic VT has a uniform QRS pattern, whereas polymorphic VT has a QRS pattern that varies from beat to beat. Monomorphic VT is the more common type, but it can be more difficult to treat because it often requires higher levels of shock energy than other rhythms.
Polymorphic VT, on the other hand, is easier to treat because it responds better to lower levels of shock energy however, it can be very dangerous and may progress to ventricular fibrillation (VF), so it’s important to intervene quickly.
Both forms of VT require immediate defibrillation and will not terminate without intervention. Therefore, if you encounter a patient in either form of VT, rapid recognition and management are essential for successful outcomes.
Ventricular Fibrillation (VF)
Ventricular Fibrillation (VF) is one of the most common shockable rhythms. VF happens when the electrical impulses that normally help organize your heartbeats, become unorganized and chaotic. This makes the lower chambers of your heart quiver instead of beat. If left untreated, VF can quickly lead to death.
Thankfully, there are ways to identify and treat VF in an emergency situation. It’s important to identify VF because it is the only shockable rhythm that should be treated with an electrical shock from a defibrillator. Here are a few signs that someone may be in VF.
The ECG will show a wavy pattern, with no identifiable intervals
The patient will not have measurable pulses or blood pressure
The patient may be unresponsive
They may have dilated pupils
They may experience muscle contractions or seizures
The treatment for VF is a synchronized shock from a defibrillator which interrupts the electrical signals causing the fibrillation and restores normal heart rhythms in some patients. Early recognition and treatment of VF is key to improving patient outcomes in cardiac arrest situations.
Pulseless Electrical Activity (PEA)
Pulseless Electrical Activity (PEA) is one of the three main shockable rhythms, and it could be the most important one to remember.
So what’s PEA? Think of it as an electrical activity that your heart still has, but there’s no mechanical activity. You can see it on the monitor but there’s not enough energy to create a pulse or blood flow to your patient. When this happens, you need to act fast.
The best course of action with PEA is to take the following steps
Establish basic life support immediately (oxygen, IV fluids, etc.)
Monitor and then analyze the rhythm for cause of arrest
Identify and correct any reversible causes identified
Administer drugs as indicated
Perform synchronized cardioversion, if indicated
Administer CPR every two minutes
Recheck rhythm every two minutes during CPR
Reassess patient after successful resuscitation
Consider referral for advanced life support
Remember, time is critical when dealing with a rhythm like PEA this means you need to act quickly and efficiently in order to provide proper care for your patient and ultimately save their life,
Asystole
Asystole is probably the most well-known of the shockable rhythms. It’s a flat line pattern (no P waves or QRS complexes) and is identified as Asystole on the monitor.
Asystole occurs when the heart has stopped beating and no electrical impulses are being sent to stimulate it. The good news is that, with advanced life support, you can sometimes revive a victim of cardiac arrest who is in asystole.
How to Resuscitate Asystole
If you observe an asystolic rhythm and a patient is unresponsive, here are your steps
Administer chest compressions and rescue breaths to create a heartbeat
Initiate an IV line and administer epinephrine to stimulate the heart
Deliver an electrical shock if needed
Continually monitor an EKG while giving medications if need be
Evaluate results and consider other treatments if necessary
With proper treatment, you may be able to restore some heart function in someone in asystole, although doctors might recommend that some victims go on life support to keep them stabilized until their hearts return to a normal rhythm. Make sure to have all your equipment readily available for any type of emergency you might face.
Algorithms for Determining Shockable Rhythms
If you want to be able to handle cardiac arrests, then you’ll need to understand shockable rhythms as well as how to determine when a shock is advised.
Fortunately, it’s easy to determine when a shock is appropriate, thanks to algorithms that are available for each type of shockable rhythm. The best thing about them? They’re simple and straightforward, allowing you to make the best decision for the patient quickly.
Algorithm for Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (VT)
The most common algorithm used for determining VF/VT includes
Quick history taking and physical examination
Assessment of the rhythm and classification of the cardiac arrest as either VF or VT
Administration of an initial shock if needed
If there is no response after one or two shocks, then administer additional shocks in rapid succession until a response is seen
Administration of CPR if there is still no response after the initial shocks
Repeat cycle until successful resuscitation or physician arrival
Algorithm for Asystole/PEA
On the other hand, if you encounter asystole or PEA, then this algorithm should be used instead
Quick history taking and physical examination
Assessment of rhythm and classification as either PEA or Asystole
Administration of CPR with chest compressions at least 100 per minute for two minutes
Defibrillation if VF/VT occurs during chest compressions
After two minutes, administration of epinephrine every three-five minutes before resuming cycles of
The bottom line is this Shockable rhythms require shockable treatment. Knowing the basics of these rhythms, understanding the danger of misdiagnosing and properly treating them is key to maintaining the health and wellbeing of individuals.
As healthcare providers, we must stay vigilant and well-versed in all shockable rhythms. It is essential that we accurately interpret the rhythms and give the appropriate treatment. The life of a patient could depend on it.
If you have any doubts about the rhythms you see, be sure to double-check and get the necessary confirmations. With the tools and training available, we can be confident in our ability to accurately diagnose and treat shockable rhythms.
