Wide-complex tachycardia: Difference between revisions
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==Treatment== | ==Treatment== | ||
*Pulseless: Unsynchronized cardioversion (defibrillation) 200J | |||
*Unstable: | |||
**Regular: Synchronized cardioversion 100-200J | |||
**Irregular: Unsynchronized cardioversion (defibrillation) 200J | |||
*Stable | |||
**Regular (tx as presumed V-tach) | |||
***Procainamide (20mg/min) | |||
***Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs) | |||
****Agent of choice in setting of AMI or LV dysfunction | |||
***Lidocaine 1-1.5mg/kg IV q5min, repeat prn until up to 300mg/hr | |||
**Irregular (tx as presumed preexcited [[A-fib]]) | |||
***Procainamide (20mg/min) | |||
***Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs) | |||
***Sotalol (100 mg IV over 5 minutes) | |||
***Mg 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for [[Torsades De Pointes]]) | |||
==DDx Regular== | ==DDx Regular== | ||
*V-tach | |||
*SVT w/ BBB (fixed or rate related) | |||
*SVT w/ accessory pathway | |||
*A flutter w/ BBB | |||
*Sinus tachycardia with BBB (fixed or rate related) | |||
==DDX Irregular== | ==DDX Irregular== | ||
*[[A-fib]]/flutter w/ variable AV conduction AND BBB (fixed or rate-related) | |||
*[[A-fib]]/flutter w/ variable AV conduction AND accessory pathway | |||
*[[A-fib]] + [[Hyperkalemia]] | |||
*Polymorphic v-tach/torsades | |||
==Disposition== | ==Disposition== | ||
Revision as of 04:17, 9 April 2015
Background
- Consider Hyperkalemia & Dig Toxicity
Diagnosis
Treatment
- Pulseless: Unsynchronized cardioversion (defibrillation) 200J
- Unstable:
- Regular: Synchronized cardioversion 100-200J
- Irregular: Unsynchronized cardioversion (defibrillation) 200J
- Stable
- Regular (tx as presumed V-tach)
- Procainamide (20mg/min)
- Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs)
- Agent of choice in setting of AMI or LV dysfunction
- Lidocaine 1-1.5mg/kg IV q5min, repeat prn until up to 300mg/hr
- Irregular (tx as presumed preexcited A-fib)
- Procainamide (20mg/min)
- Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs)
- Sotalol (100 mg IV over 5 minutes)
- Mg 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for Torsades De Pointes)
- Regular (tx as presumed V-tach)
DDx Regular
- V-tach
- SVT w/ BBB (fixed or rate related)
- SVT w/ accessory pathway
- A flutter w/ BBB
- Sinus tachycardia with BBB (fixed or rate related)
DDX Irregular
- A-fib/flutter w/ variable AV conduction AND BBB (fixed or rate-related)
- A-fib/flutter w/ variable AV conduction AND accessory pathway
- A-fib + Hyperkalemia
- Polymorphic v-tach/torsades
Disposition
- Admit all pts (even if converted to NSR with adenosine)
See Also
Source
- Rosen's