VIDEO
Wide Complex Tachycardia
The classification of ventricular tachycardia is based on several factors: ECG appearance, duration of VT, and most importantly, hemodynamic status of the patient.
? Monomorphic VT is a wide complex rhythm with a QRS duration greater than 120 ms. It originates from a single focus and is identical from beat to beat.
? Polymorphic VT varies from beat to beat.
? Non-sustained VT occurs for less than 30 seconds.
? Sustained VT lasts longer than 30 seconds.3-5,12
VT accounts for 80% of wide complex tachycardias , SVT with aberrant conduction accounts for the other, approximately 20% of cases.9,10
Scenario 1
1 – Conciousness OK
2 – Breathing OK Oxygen
3 – Pulse tachy
4- BP >90
5 – Monitor
V-tach-01-300x102.jpg
Ventricular Tachycardia
DX VT Monomorphic Stable
RX Amiodorone
Amiodarone 150mg IV over 10 min every 3-5 min, with a max of 2.2g in a 24hrs period.
Scenario 2
1 – Conciousness OK
2 – Breathing OK Oxygen
3 – Pulse tachy
4- BP >90
5 – Monitor
Wide Complex SVT because patient has RBBB
DX SupraVentricular Tachycardia (SVT) with Aberrancy Stable: RX
Adenosine 1st dose: 6mg IV then 2nd and 3rd doses: 12mg IV. Just like SVT narrow complex stable
Scenario 3
1 – Conciousness OK
2 – Breathing OK Oxygen
3 – Pulse OK
4- BP >90
5 – Monitor
Polymorphic Torsades des Pointes
Location 3
DX Torsades de Pointes
RX Magnesium Sulphate 1 to 2g IV over 2 min
Scenario 4
1 – Conciousness NOT OK
2 – Breathing NOT OK Oxygen and Possible Airway
3 – Pulse Thready
4- BP <90
5 – Monitor
V-tach-01-300x102.jpg
Ventricular Tachycardia
DX Unstable V Tach Monomorphic
Rx Cardiovert: 1st attempt with 100j, 2nd attempt with 200j, 3rd attempt with 300j, then following attempts with 360j
Scenario 5
1 – Conciousness NOT OK
2 – Breathing NOT OK Oxygen and Possible Airway
3 – Pulse Thready
4- BP <90
5 – Monitor
Ventricular Tachycardia Polymorphic Venrtricular Tachycardia Polymorphic DX Unstable Polymorphic ventricular Tachycardia
RX Defibrilate the patient at 360j with a monophasic or 120-200j with a biphasic
vfib-01-300x184.png
Ventricular Fibrillation
vfib-02-300x50.jpg
Ventricular Fibrillation
SVT-06a-RBBB-300x165.jpg
Wide Complex SVT because patient has RBBB
DX / Ventricular Tachycardia Unstable
RX Immediate Cardioversion
Scenario 2
1 – Conciousness OK
2 – Breathing OK Oxygen
3 – Pulse OK
4- BP >90
5 – Monitor
V-tach-01-300x102.jpg
Ventricular Tachycardia
DX Wide Complex Ventricular Tachycardia, Stable
RX medication
tack on friends = V tach on Ami
Amiodorone 150 mg over 10 minutes iv infusion to max dose of 2.2g /24 hrs
If VT occurs Repeat
Location 3
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