VT

Question 1

ECG criteria

Answer 1

broad QRS >200 msec
high rate >150bpm
Fusion beats
negative concordance complexes in chest leads

Question 2

List 3 possible causes of VT and the assessment features ( hx , exam , ix ) that would support it

Answer 2

ischemia : chest pain hx
electrolytes disturbance : hypokalemia , hypomagnesemia
OD : TCA( reconciliation / hx of depression)
cardiomyopathy
drugs : antipsychotics, antiarrhythmics
hypothermia

Question 3

List 3 medications that can be given to manage a patient with in a stable VT

Answer 3

in Concious VT :
IV amiodarone 300 mg loading dose then infusion of 900 mg over 24 hrs
Lignocaine 1mg/kg IV over 2 min
sotalol 1 mg/kg IV

If unstable VT : DCCV synch , if unsuscessful then unsynch

Question 4

in a patient with polymorphic VT and her GCS 14, BP 75/45
RR 25 , O2 sat : 99%RA , rhythm strip show Tds
state 3 component of your mx of this patient in resus room ?

Answer 4

2gm IV of magnesium as slow push
2-apply pads for synchronised cardioversion with procedural sedation
3-assess and treat underlying cause( HYPER K )

DO NOT use : amiodarone , sotalol , procainamide

Question 5

for persistent polymorphic VT , list 2 options for subsequent mx

Answer 5

DCCV  ( sedation for transcutaneous pacing , aim HR >100 
chemical pacing ( amiodarone , sotalol lignocaine  )