The monitor alarms and shows a wide, fast, regular rhythm. You are at the bedside within seconds. What you do next depends entirely on one thing, and it is not the strip. It is whether this client has a pulse. Ventricular tachycardia is a rapid rhythm that originates below the atrioventricular node, in ventricular muscle itself. It matters because the ventricles are the chambers that generate the pressure the body lives on, and when they beat this fast from an abnormal site, they often cannot fill or eject effectively. Some clients remain awake and talking in this rhythm. Others lose their pulse immediately. The same tracing can accompany both, which is precisely why the nurse's response is organized around assessing the client rather than around interpreting the tracing. This rhythm also has a strong tendency to degenerate into a chaotic, non-perfusing rhythm from which there is no spontaneous recovery. That is why ventricular tachycardia is never a rhythm to observe and recheck later, and why the first sixty seconds are structured, practiced, and the same every time: check responsiveness, check...