Wide-complex tachycardia
Revision as of 04:21, 9 April 2015 by Rossdonaldson1 (talk | contribs)
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