81 year old male with ischemic bowel and v tach

Started by davidoscar, February 20, 2011, 02:05:22 AM

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davidoscar

81 YEAR OLD PATIENT COMES IN THE   ER WITH AFIB VTACH HEART RATE AROUND 150-170 AND WAS DIAGNOSED WITH ISCHEMIC BOWEL TRANSFERED TO OPERATING ROOM HOLDING AREA WITH VTACH AND STABLE BP
MY ARGUMENT WAS TO COMPLETE THE DIGOXIN TREATMENT (.5MG WAS GIVEN IN ER AND THEN PATIENT WAS SENT OT OPERATING ROOM HOLDING AREA )AND CONTROL THE HEART RATE BEFORE TAKING PATIENT TO OPERATING ROOM FOR SURGERY BUT CHAIR OF ANESTHESIA WAS ADAMANT TO TAKE THE PATIENT FOR SURGERY . I TOOK MY TIME COMPLETING THE DIGOXIN TREATMENT AND BRINGING THE HEART RATE TO  120,S AND TOOK THE PATIENT TO SURGERY, IT WAS SUCCESS AND LATER IN RECOVERY ROOM PATIENT HEART RATE CAME DOWN TO 91.
MY QUESTION TO EVERYBODY IS HOW DO YOU WEIGHT THE CHEIF OF ANESTHESIA RESPONSE  WHO HAPPEN TO CMO OF HOSPITAL AS WELL .

jafo1964

There are several ways to approach a case
each with its own pro and con
if my opinion differs with my boss, I would state my view point to him and discuss.
I would document the advice given by boss and proceed as he advices

I am not certain if the ACLS guidelines recommend Digoxin as the primary drug to manage Vtach
If hemodynamically unstable - cardiovert
If stable - Amiodarone are probabaly the drugs of choice

That is just my viewpoint and since I am not your boss, you dont necessarily have to take it

reg