Severe Traumatic Brain Injury Presenting with Wide Complex Tachycardia: a Case Report

BACKGROUND: 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. OBJECTIVE: The main purpose is to emphasize the approach to treating VT in severe head trauma patients. CASE PRESENTATION: 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. CONCLUSION: 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.