Wide complex

Question 1

Strongly supportive of VT

Answer 1

QRS > 160
QRS concordance
CRS axis -90 to +/-180
H/o structural HD or MI
AV dissociation (diagnostic in 30%)

Question 2

PE findings consistent with AV dissociation

Answer 2

Cannon A waves

variability of first heart sound

Question 3

ECG evidence of AV dissociation

Answer 3

P wave rate differs from QRS (esp I, II, avF, V1)
deflection in baseline or QRS/T wave
Fusion beats, capture beats

Question 4

RBBB findings

Answer 4

QRS >120
RSR’ in V1 or V2
Wide S in I or V6

Question 5

LBBB findings

Answer 5

QRS >120
QS or rS wave in V1 (right)
Broad, monophasic R wave in left (I, V6)
mainly negative Q complex in V1

Question 6

Wide complex with RBBB pattern is likely VT if…

Answer 6

V1 pattern has Left ear higher than R AND

R wave in V6 is smaller than S wave

Question 7

Tx UNstable VT

Answer 7

Premed midazolam 1-2mg, fentanyll 25-50mcg

Shock 100J > 200J

Question 8

Tx Stable VT

Answer 8

Amiodarone 150mg over 10 min (card consult before)
Procainamide 17mg/kg IV at 20mg/min followed with 2-4mg/min
correct lytes

Question 9

Tx Monomorphic wide complex tachy

Answer 9

Adenosine 6mg IVpush > 12mg if ineffective

works for AAVRT, PSVT w/ aberrancy, RVOT

Question 10

NO ____ in irregualr wide QRS tach

Answer 10

adenosine

Question 11

Tx Torsades

Answer 11

IV mg sulfate 2gm over 5min > drip 0.5-1g/hr

Question 12

Watch for ___ with torsades tx

Answer 12

depressed DTRs

respiratory depression