Wide complex tachycardia resident survival guide: Difference between revisions

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==Management==
==Management==
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | A01='''Wide complex tachycardia'''<br>[[QRS]] ≥ 120ms}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | A01='''[[Wide complex tachycardia]]'''<br>[[QRS]] ≥ 120ms}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | A02 | | | | | A02='''Do the following simultaneously:'''<br><br>- Assess and support ABC's as needed<br>- Give [[oxygen therapy|oxygen]]<br>- Monitor [[ECG]], [[BP]], [[oxygen saturation|oxymetry]]<br>- Identify and treat reversible causes}}
{{familytree | | | | | | | | | | | | | | | A02 | | | | | A02='''Do the following simultaneously:'''<br><br>- Assess and support ABC's as needed<br>- Give [[oxygen therapy|oxygen]]<br>- Monitor [[ECG]], [[BP]], [[oxygen saturation|oxymetry]]<br>- Identify and treat reversible causes}}

Revision as of 19:38, 4 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby

Definition

Causes

Common Causes

Life Threatening Causes

Management

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wide complex tachycardia
QRS ≥ 120ms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the following simultaneously:

- Assess and support ABC's as needed
- Give oxygen
- Monitor ECG, BP, oxymetry
- Identify and treat reversible causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient stable?

Unstable signs include:
- Chest pain
- Congestive heart failure
- Hypotension
- Loss of consciousness
- Seizures
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the rhythm regular?
 
 
 
 
 
 
 
 
 
 
 
 
Immediate synchronized cardioversion

-Establish IV access
- Give IV sedation if the patient is conscious
- Consider expert consultation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Regular rhythm
 
 
 
 
 
 
 
 
 
Irregular rhythm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventricular tachycardia or uncertain rhythm?
 
SVT with aberrancy?
 
Afib with aberrancy?
 
Pre-excited Afib (Afib + WPW)?
 
Recurrent polymorphic VT?
 
Torsade de pointes?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
- 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
 
- Give adenosine 6 mg rapid IV push

- If no conversion give 12 mg IV push

- May repeat 12 mg dose once
 
- Consider expert consultation

- Control rate e.g diltiazem or beta blockers
Use beta blockers with caution in pulmonary diseases or CHF
 
- Consider expert consultation

- Avoid AV nodal blocking agents
e.g adenosine, digoxin, diltiazem and verapamil

- Consider amiodarone 150 mg IV over 10 min
 
Consider expert consultation
 
Load with Magnesium 1-2 g over 5-60 min, then infusion

Algorithm based on ACLS guidelines for the management of tachycardia.[1]

References

  1. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ; et al. (2003). "ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society". J Am Coll Cardiol. 42 (8): 1493–531. PMID 14563598.