Intensivist here. We consider sustained V-tach (defined as 30 seconds duration or greater) to be an emergency (which I define to mean that if we don't do somet

Intensivist here. We consider sustained V-tach (defined as 30 seconds duration or greater) to be an emergency (which I define to mean that if we don't do something immediately, really bad stuff could happen within seconds/minutes). Some with V-tach get goofy, some get palpitations, some get woozy/faint, some have chest pain, some have visual blurring, some get shortness of breath, some die very quickly. So while all V-tach is an "emergency", there's quite a range in its presentation. Some get no symptoms at all and can just cook along like that all day. This doesn't happen often, but I do see it from time to time. Usually my first thought is "it's not V-tach," but we usually have a good telemetry record of it. Of course, telemetry is supposed to pick that up and sound an alarm, but it isn't perfect and there are rhythm alarms going off all the time. It's a tricky situation sometimes. The ACLS guidelines are pretty good. They basically say: if someone with V-tach is "unstable" or having a lot of symptoms then shock them right away. That's generally the right approach, but it's a mean thing to do to somebody who's wide awake, but has some shortness of breath and a dip in their blood pressure. So depending on where the patient is (surgical unit, regular hospital bed, etc), some tricky logistical issues can arise (do you sedate them on the spot, which most doctors are uncomfortable doing; do you transfer them to another unit first,; do you call a code blue; do you call a rapid response team). It's why we can't put every patient into a perfect algorithm. You have to be a thoughtful human being to access the need for immediate intervention sometimes.