Wide-complex tachycardia: Difference between revisions
| Line 37: | Line 37: | ||
***[[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]]) | ***[[Magnesium]] 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for [[Torsades De Pointes]]) | ||
*Refractory | |||
**≥3 episodes within 24 hours considered [[electrical storm]] and may require alternate tx, ie beta blockade, sedation, pacing | |||
==Disposition== | ==Disposition== | ||
Revision as of 01:18, 2 June 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: see Adult pulseless arrest
- Unstable:
- Regular: Synchronized cardioversion 100-200J
- Irregular: Unsynchronized cardioversion (defibrillation) 200J
- Stable
- Regular (treat 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 (treat 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 (treat as presumed V-tach)
- Refractory
- ≥3 episodes within 24 hours considered electrical storm and may require alternate tx, ie beta blockade, sedation, pacing
Disposition
- Admit all pts (even if converted to NSR with adenosine)
See Also
Source
- Rosen's