Epidemiology and effectiveness of paramedic management of unstable pulsatile VT: Preliminary findings

Singer, S, Smith, Gavin ORCID: 0000-0003-3457-8081, STEWART, Scott ORCID: 0000-0002-9686-9100 and Stephenson, Michael (2014) Epidemiology and effectiveness of paramedic management of unstable pulsatile VT: Preliminary findings. In: Paramedics Australasia International Conference, 19 September 2014-20 September 2014, Gold Coast, Queensland.

Abstract

Introduction Ventricular Tachycardia (VT) is a life-threatening cardiac arrhythmia, with the propensity to deteriorate to cardiac arrest. The use of synchronised cardioversion as a primary therapy in terminating VT has been known since the 1950’s, however its effectiveness and safety in the pre-hospital care setting in Australia has to date not been studied to date. Aims This study aims to examine the demographics, patient characteristics and effectiveness of management in patients presenting with unstable pulsatile VT to Victorian paramedics. Methods A retrospective cross-sectional study of all cases available from Victorian Ambulance Clinical Information System (VACIS) electronic Patient Care Record database, attended by Ambulance Victoria (AV) paramedics during the period 1/7/2007 to 31/12/2013 where ventricular tachycardia (VT) was the initial rhythm assessed on ECG and synchronised cardioversion was subsequently administered as per the unstable pulsatile VT Clinical Practice Guideline. Patients in cardiac arrest, where VT was not the initial cardiac rhythm, where stable VT was the paramedic assessment, or where recorded data was incomplete were subsequently excluded. Descriptive statistics were used to report patient characteristics, demographic and basic therapy effectiveness. Results Reported are preliminary study findings describing patient characteristics, demographic data and effectiveness of synchronised cardioversion. Pre-hospital synchronised cardioversion effectively terminated VT in 94% of applications, resulting in improvements in systolic blood pressure and reduction in heart rate and respiratory rate. Mean sedation dosage prior to procedure was 4.4 mg IV midazolam. Conclusion Patients presenting with unstable pulsatile VT were predominantly male, and were aged in their early seventies with a past medical history of hypertension and myocardial infarction. Cardioversion was successful in approximately 94% of administrations. Further analysis will clarify the safety and effectiveness of this pre-hospital procedure.

Item type Conference or Workshop Item (UNSPECIFIED)
URI http://vuir.vu.edu.au/id/eprint/26764
Official URL http://ajp.paramedics.org/index.php/ajp/article/vi...
Keywords Victorian paramedics; patient demographic; patient characteristics; prehospital procedure; ambulance paramedics
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