Tachycardia, Wide Complex

Question 1

What kind of patient history should you get?

Answer 1

• OPQRST/SAMPLE
• Hx of WPW, a-Fib, cardiac ablations, HTN, hyperlipidemia, MI
• Hx of syncope/near syncope
• Hx of stimulant use (cocaine, caffeine, Ritalin)

Question 2

What does WPW stand for?

Answer 2

Wolff-Parkinson-White

Question 3

What are some s/s?

Answer 3

• Heart rate ≥100 bpm
• Dizziness, lightheadedness, syncope, chest pain, fatique, SOB
• Acute CHF (peripheral edema, pulmonary crackles/rales, hypoxia)
• Hypotension, shock AMS, pale/cyanotic, diaphoretic

Question 4

What does CHF stand for?

Answer 4

Congested Heart Failure

Question 5

What does CHAPS stand for?

Answer 5

• Chest pain
• Hypotension
• AMS
• Pulmonary edema
• S/s of shock

Question 6

What are the guidelines for SL1?

Answer 6

• General patient care
• Airway management

Question 7

What are the guidelines for SL2?

Answer 7

• Asymptomatic
• EtCo2
• Cardiac monitoring

Question 8

What do you do with asymptomatic patients?

Answer 8

Closely monitor and there is no immediate intervention

Question 9

What happens when a patients on EtCO2?

Answer 9

They will be on constant monitoring

Question 10

How often will you obtain a serial EKG?

Answer 10

q 10 min; transmit if able

Question 11

What should you consider if the patient shows s/s of unstable tachycardia?

Answer 11

CHAPS
- Chest pain
- Hypotension
- AMS
- Pulmonary edema
- s/s of shock

Question 12

Who should you not give amiodarone to?

Answer 12

Pregnant patients due to the risk of fetal bradycardia

Question 13

What is a substitute for amiodarone?

Answer 13

Procainamide

Question 14

How should adenosine should be administered?

Answer 14

Directly to the IV hub via a 2-way stopcock connected to Adenosine dose and a 10mL flush