Adult wide complex tachycardia Flashcards
What are Zoll’s recommendation for energy settings in cardioversion?
Synchronized cardioversion out: 100 J – 120 J – 150 J – 200 J
What are the recommended doses for Amiodarone in the case of wide complex tachycardia with a pulse?
150 mg over 10 minutes, repeat once to a max of 300 mg.
If conversion is obtained, mix 450 mg in 250 mL and administer via IV pump at 1 mg/min.
What are the lidocaine recommendations for wide complex tachycardia with a pulse?
1–1.5 mg/kg slow IV boluse followed by .5 to .75 mg/kg every five minutes. Not to exceed 300 mg in 30 minutes.
Be sure to re-bolus in the first 8 to 10 minutes or begin infusion to maintain therapeutic levels.
Maintenance infusion: 2 to 4 mg/min. Start at 2 mg/min and add an additional milligram per minute for every 1 mg/kg from the IV bolus.
1 mg/kg bolus= 2 mg/min
1.5 mg/kg bolus= 2.5 mg/min
How to tell the difference between ventricular tachycardia and SVT with aberrancy?
SVT:
QRS complex < 160 ms (4 small squares) but QRS is still > 120 ms
No capture beats
No Brugada’s sign
No Josephson’s sign
RSR complex with taller right rabbit ear
VT:
QRS complex > 160 ms (4 small squares)
There may be occasional capture beats (normal QRS complex in the middle of a run of VT complexes)
Brugada’s sign- distance from the beginning of the QRS complex to the lowest point (nader) of the S wave = > 100 ms (2.5 small squares)
Josephson’s Sign- notching near the Nader of the S wave.
RSR complex with taller left rabbit ear
When should adenosine be given in wide complex Tachycardia? What are the doses?
Adenosine should be administered when SVT with abberancy is suspected.
6 mg followed by 12 mg followed by 12 mg. Each dose should be immediately followed by rapid flush of 20 to 60 mL of normal saline.
What is magnesium sulfate used to treat? And what is the dose?
Treats torsades, refractory VF/VT, or wide complex tachycardias suspected to be associated with hypomagnesemia or digitalis toxicity.
2 g over two minutes, and repeat every five minutes as necessary or until 8 g max is reached.
When is the first said contra indicated For sedation prior to cardioversion?
Blood pressure is below 90 systolic, lower respiratory rate, altered mental status, or low oxygen saturation.
