Wide-complex tachycardia: Difference between revisions
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#A.fib + BBB | #A.fib + BBB | ||
#A.fib + rate related BBB | #A.fib + rate related BBB | ||
## | ##QRS widest with shortest R-R | ||
#V. tach | #V. tach | ||
#A.fib + hyperkalemia or meds | #A.fib + hyperkalemia or meds | ||
#Accessory pathway | #Accessory pathway | ||
##The danger = A.fib + aberrant pathway (in WPW) | |||
#The danger = A.fib + aberrant pathway (in WPW) | ###do not use adenosine, beta blockers, dilt, or dig | ||
##do not use adenosine, beta blockers, dilt, or dig | ###changing morphology of QRS = inc poss | ||
##changing morphology of QRS = inc poss | ###consider procainamide or ibutilide (amiodarone?) | ||
##consider procainamide or ibutilide (amiodarone?) | ###shock if becomes unstable | ||
##shock if becomes unstable | |||
==REFRACTORY V-TACH== | ==REFRACTORY V-TACH== | ||
Revision as of 17:30, 9 April 2011
Background
Consider hyperkalemia & dig toxicity
Treatment (Wide)
- Pulseless --> shock (sync 360J)
- Unstable --> shock (sync 100J -200J monophasic, or 50-100J biphasic)
- Stable
- Regular
- Tx as presum V.Tach
- Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs)
- Procainamide (15-18mg/kg over 30 min)
- May cardiovert
- See Refractory
- Tx as presum V.Tach
- Irregular
- HR <200
- Presum aberrant a. fib
- HR 200-250
- HR >250
- HR <200
- Regular
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 (amiodarone?)
- shock if becomes unstable
- The danger = A.fib + aberrant pathway (in WPW)
REFRACTORY V-TACH
- Overdrive pacing
- Lidocaine
- Magnesium
- Electrolytes
- ?dilantin
See also
Source
Rosen's