What are the immediate management steps for a patient presenting with sustained ventricular tachycardia in primary care?

Immediate management of sustained ventricular tachycardia (VT) in primary care requires urgent assessment and intervention to stabilise the patient and prevent deterioration. First, assess the patient’s airway, breathing, and circulation (ABCs) and check for haemodynamic instability, such as hypotension, altered consciousness, chest pain, or signs of shock. If the patient is haemodynamically unstable, immediate synchronized electrical cardioversion is indicated to restore sinus rhythm without delay ¹ (Buxton et al., 2001; Deyell et al., 2020).

If the patient is haemodynamically stable but has sustained VT, urgent referral to secondary care is essential for further evaluation and management, as antiarrhythmic drug therapy and advanced interventions are typically beyond primary care scope ¹ (Buxton et al., 2001; Deyell et al., 2020). While awaiting transfer, continuous monitoring and supportive care should be provided, including oxygen if hypoxic and intravenous access for potential medication administration.

In cases where immediate cardioversion is not available and the patient is unstable, basic life support and rapid transfer to emergency services are critical. Use of antiarrhythmic drugs such as amiodarone may be considered only if trained personnel and protocols are in place, but this is generally reserved for hospital settings ¹ (Buxton et al., 2001; Deyell et al., 2020).

Overall, the priority in primary care is rapid recognition, assessment of stability, initiation of resuscitation if needed, and urgent transfer to hospital for definitive management ¹ (Buxton et al., 2001; Deyell et al., 2020).