Department of Emergency Medicine, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Department of General Surgery, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Med Arch. 2023;77(4):306-309. doi: 10.5455/medarh.2023.77.306-309.
Ventricular tachycardia (VT) is an abnormal heart rhythm that can lead to pump failure and hypoperfusion. Its causes, presentation, and treatment are well established in the literature. However, the VT treatment algorithm is based on non-traumatic patients. Due to different pathophysiology and presentation, treating VT in trauma patients should be different.
The main purpose is to emphasize the approach to treating VT in severe head trauma patients.
This case is a unique presentation of severe head trauma with a paucity of treatment approaches in the literature. In this article, we present a case of a middle-aged male patient presented to a level one trauma center with a history of falls from 2 stories height with a Glasgow Coma Scale (GCS) of 3/15. ATLS approach was followed in treating this patient, his rhythm strip showed a wide complex regular rhythm, likely representing a VT with a pulse. The patient was treated as unstable because of a decreased level of consciousness. A 100 J synchronized cardioversion was given without restoration of normal sinus rhythm, followed by Mannitol 1g/kg, treating the possibility of high intracranial pressure (ICP), after which his rhythm was restored to sinus.
The restoration of sinus rhythm after treating the possibility of high ICP suggests that the cause of VT in this severe TBI patient was the high ICP.
室性心动过速（VT）是一种异常的心律，可导致泵衰竭和灌注不足。其病因、表现和治疗在文献中已有明确记载。然而，VT 的治疗算法是基于非创伤患者的。由于病理生理学和表现不同，创伤患者的 VT 治疗应该有所不同。
主要目的是强调严重头部创伤患者 VT 的治疗方法。
本例为严重头部创伤的独特表现，文献中治疗方法较少。本文介绍了一名中年男性患者的病例，该患者从 2 层楼高坠落，格拉斯哥昏迷量表（GCS）评分为 3/15，就诊于一级创伤中心。按照 ATLS 方法治疗该患者，其节律带显示宽复合规则节律，可能代表有脉搏的 VT。由于意识水平下降，患者被视为不稳定。给予 100J 同步电复律，但未能恢复正常窦性心律，随后给予 1g/kg 甘露醇，以治疗可能存在的颅内压（ICP）升高，之后其节律恢复为窦性。
治疗可能存在的高 ICP 后窦性节律的恢复表明，该严重 TBI 患者 VT 的原因是高 ICP。
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