OSCE — Ventricular Tachyarrhythmias

Brief (to candidate)

You will assess a patient with a presentation consistent with Ventricular Tachyarrhythmias.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Ventricular tachyarrhythmias are rapid rhythms originating below the bundle of His that produce a broad QRS complex (over 120 ms) and span a continuum from monomorphic ventricular tachycardia (VT) through polymorphic VT (including torsades de pointes) to ventricular fibrillation (VF). Sustained VT with pulse is treated with IV amiodarone 300 mg if stable, or synchronised DC cardioversion if unstable; pulseless VT and VF are shockable rhythms managed by the ALS algorithm (immediate unsynchronised defibrillation, CPR, adrenaline 1 mg every 3 to 5 min, amiodarone 300 mg after the third shock). The 2022 ESC / 2017 AHA/ACC/HRS guidelines govern long-term management: implantable cardioverter-defib

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.