Wide-complex tachycardia: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Pulseless | #Pulseless: Unsynchronized cardioversion 200J | ||
#Unstable | #Unstable: Synchronized cardioversion 100-200J | ||
#Stable | #Stable | ||
##Regular (tx as presumed V-tach) | ##Regular (tx as presumed V-tach) | ||
###Synchronized cardioversion (100 J) | ###Synchronized cardioversion (100 J) | ||
###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]]) | ##Irregular (tx as presumed preexcited [[A-fib]]) | ||
###Unsynchronized cardioversion (200J) | |||
###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) | ||
## | ##Mg 1-2gm IV over 60-90s, then infuse 1-2gm/hr (for [[Torsades De Pointes]]) | ||
==DDx Regular== | ==DDx Regular== | ||
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==Source == | ==Source == | ||
Rosen's | *Rosen's | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 05:42, 26 March 2012
Background
- Consider Hyperkalemia & Dig Toxicity
Diagnosis
Treatment
- Pulseless: Unsynchronized cardioversion 200J
- Unstable: Synchronized cardioversion 100-200J
- Stable
- Regular (tx as presumed V-tach)
- Synchronized cardioversion (100 J)
- 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)
- Unsynchronized cardioversion (200J)
- 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