all right welcome back everybody to another video lesson from ICU advantage this is going to be the fifth lesson in this series in which we are talking about arrhythmias and in this lesson we're going to cover the ventricular arrhythmias [Music] all right welcome back you guys like I talked about this is gonna be the fifth lesson in this series covering EKG an ECG interpretation and we're gonna continue on with our coverage of arrhythmias in the last lesson we took a look at the atrial and junctional rhythms which I will link to up above here but in this lesson we're gonna take a look at those various ventricular rhythms and these ones are especially important because a few of these can be pretty serious for your patient but before we begin if this is your first time to this channel and you want to see more of this in-depth critical care educational content such as this please do subscribe below make sure you hit that notification bell though and select all notifications to ensure you're alerted as soon as our new videos become available we really value your subscription your likes and your comments as they really go a long way to help support this channel in our videos so for that I do want to thank you guys and for those of you who don't know my name is Eddie Watson and I'll be presenting this lesson for you today and with that said let's go ahead and start our dive into our ventricular arrhythmias and the first of these that we're going to talk about is our idioventricular rhythm or our IVR and this idioventricular rhythm is gonna be the result of when either the SA node or the AV node are either not firing or not sending their signals down when they are firing or if they're sending them at such a slow rate that the ventricular intrinsic rate or the intrinsic rate of the bundle of hiss or the Purkinje fibers take over and begin to at least get some sort of contraction and some sort of cardiac output so just to go over some of the defining characteristics before we talk about this a little bit more first you're gonna have a wide QRS you're gonna have absent p-waves and finally you're gonna have a heart rate that falls within our ventricular intrinsic rate of 20 to 40 now this is important to know because at this rate and without having that atrial kick due to that absent P wave that this is not usually going to have a sufficient cardiac output and so this is potentially a life-threatening condition that your patient is in and so just looking at our example here you can see we've got that really wide QRS you can see there's not any P wave anywhere around here and definitely counting this out we've got 1 2 3 therefore a heart rate of 30 therefore we can definitely identify this as an idioventricular rhythm now just like with our junctional rhythms sometimes you're gonna see faster heart rates than what's normally within that intrinsic ventricular rate and so we do have a couple other variations of this that we're going to talk about and the first one is called accelerated idioventricular rhythm or a IVR and just like with the junctional rhythms everything about this rhythm is going to be the same as our idioventricular rhythm other than we're gonna have a heart rate between 40 and 100 now just like with our junctional rhythm we can also find ourselves in a situation where we have a ventricular rhythm with a rate that's greater than 100 and that leads us to the next ventricular rhythm that we're going to cover here our ventricular tachycardia or often time referred to as v-tach and in this example here this is our monomorphic v-tach and basically what that means is we only have one kind of morphology of ventricular rhythm going on here as you can see each of these ventricular rhythms are basically about the same telling us that this is originating from the same spot now with v-tach this has the potential to be a very serious thing for your patient you can find a patient though who still has a pulse and still is awake and talking while they're in a slow v-tach but probably more common of what you're gonna see is a patient who's pulseless and therefore this is potentially a lethal rhythm so it's definitely gonna be important that you guys are able to identify this rhythm because especially in the ICU unfortunately you're gonna see this one pretty often there's a few different things that can cause our patient to go into v-tach the first of these can be myocardial ischemia you can have an R on T event can also happen as a result of cardiac drug toxicity ventricular irritation or even electrolyte imbalance so again some of our defining characteristics for this we're gonna definitely have that wide QRS complex again this is originating from within the ventricle and that signal is not traveling quickly down that bundle of hiss and the bundle branches you're also going to have no discernable P way and for this to be VTEC you've got to have a heart rate greater than 100 and like we said the patient may still have a pulse with this typically when we have some of these slower v-tex but even those can deteriorate pretty quickly and progress into an even more lethal ventricular rhythm which we'll talk about next but sometimes you'll see heart rates that are in the two hundreds or even close to 300 with v-tach now before we move to that next ventricular rhythm I do want to show another variation of a different kind of v-tach and this is something that we call torsades which is essentially our polymorphic v-tach and the reason we call this polymorphic is because that origination of that irritated ventricular signal is moving around throughout the heart and not coming from the same place therefore if you look at the morphology of say these beats here compared to these beads here and compared to these beats here you see that they're quite different telling us that these impulses are coming from different parts of the heart and therefore being captured differently on our ECG this is another one of those very interesting rhythms and more often than not this is going to be a pulseless rhythm for your patient so this is also another lethal rhythm and typically as a result of either prolong QT or some sort of electrolyte imbalance that's really about all I'm going to cover on it for the purpose of this lesson but just know that this is going to be a different form of v-tach that you're gonna have to be able to identify alright so now we're moving on to the last of the ventricular rhythms that we're going to talk about and this is one that we call ventricular fibrillation and this example that we're showing you here is an example of a coarse v-fib now with v-fib unlike v-tach there's no chance that your patient's having a pulse with this one therefore this one is absolutely a lethal rhythm and will require immediate intervention on your part think here ACLs and coding your patient now just as the name suggests ventricular fibrillation is just that fibrillation of the ventricles so just like we talked about with atrial fibrillation those ventricles are not having an organized contraction and they're just quivering or fibrillating and essentially you're not really getting any sort of blood flow out of the heart hence this being such an emergency to have to deal with so it's pretty easy to identify when you're looking at it but it does have that chaotic rhythm but you're not gonna have any QRS complexes so again you've got no cardiac output I can't stress this enough lethal rhythm you've got to know this one and this example here like I said is a coarse v-fib and the reason that we call this a coarse v-fib is because we still have some large unorganized rhythms going on here whereas if we look at the next example here with our fine ventricular fibrillation you can now see that you have much smaller tracings on your ECG and really the reason for this is you have less electrical energy that's happening within the myocardium and so unfortunately if you're seeing this in your patient you probably have less of an opportunity for a successful differe ablation so hopefully if you are gonna see this or encounter this with your patient that you can catch it early while it's still in that course v-fib stage because once we progress to this point you're gonna have a much harder time getting that patient back all right on that note that is gonna wrap up this lesson in which we have talked about our ventricular arrhythmias so we've done a pretty good review of these various ventricular rhythms that you're gonna see from our IVR to our a IVR and then progress that into our ventricular tachycardia or v-tach and some of the different variations that you're going to see with that and finally we rounded it out covering ventricular fibrillation or v-fib again in a couple different variants that you're going to see this but the vast majority these ventricular rhythms are absolutely vital that you guys are able to recognize these and be able to interpret these because for the most part they either require some sort of immediate intervention or will lead to some sort of emergent intervention for your patients such as initiating ACLs or something to that effect so very important that you guys know these ones hopefully this lesson was able to give you the tools and the knowledge you need to be able to properly interpret these on a rhythm and so with that said I do want to thank you guys so much for watching again I really hope that you found this information useful and if you did go down in those likes below and leave us a like it really does help to support our channel here and we really appreciate it in the next and final lesson in this series we're gonna take a look at all the different various forms of heart block that you could potentially find in your patient so if you haven't already subscribed to our channel below in order to get the notification as soon as that lesson becomes available otherwise in the meantime head on over and check out one of our most recent lessons that we put together covering arterial blood gases all right you guys will thanks so much for watching you guys have a great day