Unknown wide-complex tachycardia Flashcards
Unknown wide-complex tachycardia Definition:
Wide QRS > 120 ms, Tachycardic > 100 beats/min
Unknown wide-complex tachycardia DDX:
Ventricular tachycardia
SVT with aberrancy (BBB, WPW)
Paced rhythms
A fib with WPW
Torsade de pointes
Drug overdose
Na channel blockers
Hyperkalemia
Post-resuscitation
Artifact
Unknown wide-complex tachycardia ASAP:
ASAP: Pulse?, stable vs unstable, ABCs, IV, O2, EKG, monitor/defib
Unknown wide-complex tachycardia if no pulse…
If no pulse… go to pulseless arrest algorithm (CPR, Shock, Epi, etc)
Unknown wide-complex tachycardia If pulse but unstable…
If pulse but unstable… sync’d cardioversion
Unknown wide-complex tachycardia If regular and likely VT or uncertain…
If regular and likely VT or uncertain… Amiodarone 150 mg IV, then 1 mg/min (may repeat bolus) and/or elective sync’d cardioversion
Unknown wide-complex tachycardia If polymorphic VT (torsades)…
If polymorphic VT (torsades)… Mg 2-4 gm IV, stop any meds that prolong QT
Unknown wide-complex tachycardia If regular and likely SVT…
If regular and likely SVT… ACC/AHA say you can do Adenosine 6 mg IV (may repeat w 12mg x 2 if no effect) BUT JUST ASSUME VTACH AND give electricity
Unknown wide-complex tachycardia If irregular
If irregular (afib with aberrancy- control rate) (A fib + WPW- avoid AV nodal blocking agents)
Unknown wide-complex tachycardia If Regular really wide complex tachy-think metabolic or toxin- QRS >200
If Regular really wide complex tachy-think metabolic or toxin- QRS >200
Avoid Na channel blocker-amio, lido, procain
Give Ca and bicarb
More splintered, fractionated or notched QRS more likely…
More splintered, fractionated or notched QRS more likely VT
Any really wide WCT consider…
Any really wide WCT consider tox or metabolic
