Sandbox 131

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Wide complex tachycardia QRS ≥ 120ms                                                                                                   Begin initial management                                                                                                   Determine if the patient has any unstable sign or symptom                                                                                                                     No               Yes                                                                               Determine the regularity of the rhythm               Perform immediate synchronized cardioversion                                                                                 Regular rhythm               Irregular rhythm                                                                                                               VT or uncertain rhythm   SVT with aberrancy   Afib with aberrancy   Pre-excited Afib (Afib + WPW)   Recurrent polymorphic VT   Torsade de pointes

Begin initial management ❑ Assess and support ABC's as needed ❑ Give oxygen ❑ Monitor ECG, blood pressure, oxymetry ❑ Establish IV access ❑ Identify and treat reversible causes Determine if the patient has any unstable sign or symptom ❑ Chest pain ❑ Congestive heart failure ❑ Hypotension ❑ Loss of consciousness ❑ Seizures Perform immediate synchronized cardioversion ❑ Perform immediate synchronized cardioversion ❑ Give IV sedation if the patient is conscious ❑ Consider expert consultation VT or uncertain rhythm ❑ Give amiodarone 150 mg IV over 10 min ❑ Repeat amiodarone as needed for a maximal dose of 2.2g/24h ❑ Prepare for elective synchronized cardioversion SVT with aberrancy ❑ Attempt vagal maneuvers ❑ Give adenosine 6 mg rapid IV push ❑ If no conversion give 12 mg IV push ❑ May repeat 12 mg dose once Afib with aberrancy ❑ Consider expert consultation ❑ Control rate e.g diltiazem or beta blockers Pre-excited Afib (Afib + WPW) ❑ Consider expert consultation ❑ Avoid AV nodal blocking agents e.g adenosine, digoxin, diltiazem and verapamil ❑ Consider amiodarone 150 mg IV over 10 min Recurrent polymorphic VT ❑ Consider expert consultation Torsade de pointes ❑ Load with magnesium 1-2 g over 5-60 min, then infusion