Broad Complex Tachycardia

Question 1

Definition of Broad complex tachycardia:

Answer 1

1. ECG shows rate of >100bpm
2. QRS complexes >120ms (>3 small squares on ECGS done at the standard UK rate of 25mm/s

Question 2

Initial Mx:

Answer 2

1. Check pulse
2. O2 if sats < 94%
3. IV access
4. ECG
5. Check for adverse signs - Systolic BP ≤90mmHg, Chest pain/ischaemia on ECG, Heart failure, Heart rate ≥ 150bpm

Question 3

Mx if NO adverse signs present & REGULAR rhythm:

Answer 3

1. Assume VT
2. Give amiodarone 300mg IV over ≥20min
3. Then 900mg over 24h, all via central line
4. If known history of SVT and BBB consider adenosine as alternative to amiodarone

Question 4

Mx if NO adverse signs present & IRREGULAR rhythm:

Answer 4

Dx usually:

1. AF with bundle branch block
2. Pre-excited AF - consider
   amiodarone
3. Polymorphic VT - torsade de
   pointes - give Mg2+ 2g IVI

Question 5

Mx if ADVERSE signs PRESENT:

Answer 5

1. Call for help
2. Sedate
3. Up to 3 synchronized DC shocks: 150–200J for the first - then 150–360J subsequently (biphasic)
4. **Amiodarone 300mg IV **over ≥20min; then 900mg over 24h via central line
5. Check and correct K+ and Mg2+
6. Further cardioversion if needed

Question 6

Full Mx algorithm:

Answer 6