Wide-complex tachycardia

• Consider hyperkalemia & dig OD

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
• Irregular**
• HR <200
• Presum aberrant a. fib**
• HR 200-250
• HR >250

*DDx Regular

1) V. tach

2) Tachycardia + BBB

3) Tachycardia + rate related BBB

4) Hyperkalemia, meds (e.g. procainamide, flecainide, TCAs, dig)

5) Pacemaker

6) Tachycardia + Accessory pathway

V-TACH (BRUGADA CRITERIA)

• Regular rhythms only

Any 1 of the following = Vtach:

(matters only if stable, for drug choice)

1) Absence of RS complex in all precordial leads

2) RS >100ms (>2.5mm) in any precordial

3) AV dissociation (fusion beats)

4) Morphology criteria for VT in V1 or V6 (clear R/L-BB pattern)

**DDX Irregular

1) A.fib + BBB

2) A.fib + rate related BBB

(QRS widest with shortest R-R)

3) V. tach (see Brugada Criteria)

4) A.fib + hyperkalemia or meds

6) 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

REFRACTORY V-TACH

Overdrive pacing

Lidocaine

Magnesium

Electrolytes

?dilantin

See also

Cards: V TACH Vs. Aberrant SVT

Source

8/07 DONALDSON (adapted from EM, Rosen)