RRAPID: Broad Complex Tachycardias

Question 1

Definition of Broad Complex Tachycardia? (3)

Answer 1

ECG rate > than 100 bpm
QRS complexes > 0.12 seconds (3 small squares)
Presence of a pulse (if no pulse start ALS)

Question 2

Causes? (5)

Answer 2

Broad QRS complex either caused by: bundle branch block or incorrect involvement of AV node:

VT (usually regular rhythm)
SVT
AF (irregular)
Wolf-Parkinson-White syndrome
Atrial tachycardia with aberrant conduction

Question 3

Response (Airway)?

Answer 3

O2 15 L/min via reservoir mask

Question 4

Response (Breathing)?

Answer 4

Monitor O2 sats

Question 5

Response (Circulation)?

Answer 5

Monitor BP
IV access (fluids)
Bloods: FBC, U&E's, LFT's, calcium, magnesium, glucose
Blood cultures (if sepsis indicated)
Attach to cardiac monitor
12 lead ECG 
Identify and treat underlying cause.

Question 6

What are the adverse feature to be identified? (4)

Answer 6

Shock (systolic BP <90mmHg
Syncope
Myocardial ischaemia
Heart Failure

Question 7

Rx of BCT with adverse features?

Answer 7

Synchronised DC (defibrillation & cardioversion) SHOCK (3 times)

Amiodarone 300 mg IV (over 10-20 mins)
Repeat SHOCK

Amiodarone 900 mg IV (over 24 hrs)

Question 8

Rx of Regular BCT without adverse features?

Answer 8

Amiodarone 300 mg IV loading dose (over 1hr)
(Loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose)

Amiodarone 900 mg IV (over 24 hrs)

Question 9

Rx if previously confirmed SVT with bundle branch block?

Answer 9

Adenosine

Question 10

Rx of irregular BCT without adverse features?

Answer 10

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