Template:ACLS Wide Irregular Tachycardia

Wide Irregular Tachycardia

Wide Irregular Tachycardia (consistent with Torsades De Pointes).

DO NOT use AV nodal blockers as they can precipitate V-Fib

Pulseless: see Adult pulseless arrest

• Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
  • Unsynchronized cardioversion (defibrillation) 200J
• Stable:
• A fib with preexcitation
  • 1st line - Electric Cardioversion
  • 2nd line - Procainamide, amiodarone, or sotalol
• A fib with aberrancy
• Polymorphic V-Tach / Torsades De Pointes
  • Give IV MgSO4
  • Emergent defibrillation (NOT synchronized)
  • Correct electrolyte abnormalities (esp hypoK, hypoMg)
  • Stop prolonged QT meds