Outline your ICU management of an ICU patient with ventricular tachycardia
Pulseless VT: managed as per cardiac arrest protocol (immediate unsyncbronised defibrillation [up to 3 sequential shocks if necessary], followed by CPR intubation/IV/oxygen, consider antiarrhythmics (lignocaine, amiodarone, potassium and magnesium], administer adrenaline 1 mg every 3 minutes, exclude reversible causes [5Hs and 5Ts].
VT with a pulse: if deteriorates or unstable haemodynamically manage as for pulseless VT.If stable administer oxygen/obtain IV access and rapidly exclude reversible factors (including wire catheter in RV, hypokalaemia, hypomagnesaemia, others as indicated by a systematic review to exclude other reversible causes. Drug therapy according to scenario but useful drugs include lignocaine (for ischaemia/post cardiac surgery: 1-1.5 mg/kg IV then infusion), procainamide (50 mglmin to max of 17 mglk.g),sotalol (l mglkg) or amiodarone (5 mg/kg over 20 minutes).
The question draws on the candidate's knowledge of recent resuscitation guidelines.
The ARC has a pretty straightforward view of these sort of tachyarrhythmias. If it is hemodynamically usntable, you shock it. If it is haemodynamically stable, you can afford to think about drugs. If it is without pulse, the patient is dead and you should proceed according to the ALS algorithm for shockable rhythms (nowadays we dont do those three shocks anymore).
Pellegrini, Cara N., and Melvin M. Scheinman. "Clinical management of ventricular tachycardia." Current problems in cardiology 35.9 (2010): 453-504.
Hazinski, Mary Fran, et al. "Part 1: Executive Summary 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." Circulation 122.16 suppl 2 (2010): S250-S275.