Case 3
Ethan Krauspe, Richa Sheth
Case 3
24F with receiving antipsychotics and anti-emetics collapses on telemetry and is pulseless.
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Rhythm? Next Step?
EKG analysis
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Polymorphic VT (= TdP if QTc is long)
EKG analysis
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Monomorphic VT
Team interface prompt
The medication history matters.
Ask nursing/pharmacy:
“What QT-prolonging medications has she received, and when was the last dose?”
Then say the rhythm plan out loud.
Learning Points
Sustained polymorphic VT is unstable: shock immediately with unsynchronized high-energy defibrillation because synchronization may fail. If recurrent TdP with long QT, give magnesium, address bradycardia/QT drivers, and ask for expert help for overdrive pacing or isoproterenol.
QT prolongation more dangerous with slow HR
Case summary
Label: Polymorphic VT/TdP after QT-prolonging medications.
Key issue: sustained polymorphic VT needs immediate unsynchronized shock; recurrent long-QT/TdP needs magnesium, QT-driver correction, and expert help.
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