Wide-complex tachycardia: Difference between revisions
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####Mag 1-2gm IV over 60-90s, then infuse 1-2gm/hr | ####Mag 1-2gm IV over 60-90s, then infuse 1-2gm/hr | ||
###Synchronized cardioversion (100 J) | ###Synchronized cardioversion (100 J) | ||
##Irregular | ##Irregular (tx as presumed preexcited a-fib) | ||
###Unsynchronized cardioversion (200J) | ###Unsynchronized cardioversion (200J) | ||
Revision as of 21:11, 10 May 2011
Background
- Consider hyperkalemia & dig toxicity
Treatment
- Pulseless - Unsynchronized cardioversion 200J
- Unstable - shock (sync 100J -200J monophasic, or 50-100J biphasic)
- Stable
- Regular (tx as presumed V-tach)
- 1st Line
- Procainamide (20mg/min)
- Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs)
- Agent of choice in setting of AMI or LV dysfunction
- 2nd Line
- Lidocaine 1-1.5mg/kg IV q5min, repeat prn until up to 300mg/hr
- Torsades de Pointes
- Mag 1-2gm IV over 60-90s, then infuse 1-2gm/hr
- Synchronized cardioversion (100 J)
- 1st Line
- Irregular (tx as presumed preexcited a-fib)
- Unsynchronized cardioversion (200J)
- Regular (tx as presumed V-tach)
DDx Regular
- V-tach
- Tachycardia + BBB
- Tachycardia + rate related BBB
- Hyperkalemia, meds (e.g. procainamide, flecainide, TCAs, dig)
- Pacemaker
- Tachycardia + Accessory pathway
- See V Tach vs. SVT
DDX Irregular
- A-fib + BBB
- A-fib + rate related BBB
- QRS widest with shortest R-R
- V-tach
- A-fib + hyperkalemia or meds
- Accessory pathway
- The danger = A.fib + aberrant pathway (in WPW)
- Do not use adenosine, beta blockers, dilt, or dig
- Changing morphology of QRS = inc poss
- Consider procainamide or ibutilide
- Shock if becomes unstable
- The danger = A.fib + aberrant pathway (in WPW)
See also
Source
Rosen's