Wide-complex tachycardia: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Consider [[Hyperkalemia]] & [[Dig Toxicity]] | *Consider [[Hyperkalemia]] & [[Dig Toxicity]] | ||
==Differential Diagnosis== | |||
==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) | |||
==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]] | |||
==Diagnosis== | ==Diagnosis== | ||
| Line 8: | Line 22: | ||
==Treatment== | ==Treatment== | ||
*Pulseless: Unsynchronized cardioversion (defibrillation) 200J (See [[Adult pulseless arrest]]) | *Pulseless: Unsynchronized cardioversion ([[defibrillation]]) 200J (See [[Adult pulseless arrest]]) | ||
*Unstable: | *Unstable: | ||
**Regular: Synchronized cardioversion 100-200J | **Regular: Synchronized cardioversion 100-200J | ||
**Irregular: Unsynchronized cardioversion (defibrillation) 200J | **Irregular: Unsynchronized cardioversion ([[defibrillation]]) 200J | ||
*Stable | *Stable | ||
**Regular (tx as presumed V-tach) | **Regular (tx as presumed V-tach) | ||
***Procainamide (20mg/min) | ***[[Procainamide]] (20mg/min) | ||
***Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs) | ***[[Amiodarone]] (150mg over 10min, then 1mg/min gtt x 6hrs) | ||
****Agent of choice in setting of AMI or LV dysfunction | ****Agent of choice in setting of AMI or LV dysfunction | ||
***Lidocaine 1-1.5mg/kg IV q5min, repeat prn until up to 300mg/hr | ***[[Lidocaine]] 1-1.5mg/kg IV q5min, repeat prn until up to 300mg/hr | ||
**Irregular (tx as presumed preexcited [[A-fib]]) | **Irregular (tx as presumed preexcited [[A-fib]]) | ||
***Procainamide (20mg/min) | ***[[Procainamide]] (20mg/min) | ||
***Amiodarone (150mg over 10min, then 1mg/min gtt x 6hrs) | ***[[Amiodarone]] (150mg over 10min, then 1mg/min gtt x 6hrs) | ||
***Sotalol (100 mg IV over 5 minutes) | ***[[Sotalol]] (100 mg IV over 5 minutes) | ||
*** | ***[[Magnesium]] 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for [[Torsades De Pointes]]) | ||
==Disposition== | ==Disposition== | ||
Revision as of 04:21, 9 April 2015
Background
- Consider Hyperkalemia & Dig Toxicity
Differential Diagnosis
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)
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
Diagnosis
- Assume ventricular tachycardia until proven otherwise
- See V Tach vs. SVT
Treatment
- Pulseless: Unsynchronized cardioversion (defibrillation) 200J (See Adult pulseless arrest)
- 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)
- Magnesium 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for Torsades De Pointes)
- Regular (tx as presumed V-tach)
Disposition
- Admit all pts (even if converted to NSR with adenosine)
See Also
Source
- Rosen's