Wide complex tachycardia medical therapy: Difference between revisions
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* Though ACLS guidelines recommend a diagnostic trial of [[Adenosine]], it can precipitate [[VF]] in some patients with SVT. Patients who have underlying coronary disease may become ischemic from coronary steal. Rhythm can degenerate and lead to [[VF]] that cannot be resuscitated. Furthermore, some [[VT]] (esp those with structurally normal hearts) are [[adenosine]] responsive and can terminate. | * Though ACLS guidelines recommend a diagnostic trial of [[Adenosine]], it can precipitate [[VF]] in some patients with SVT. Patients who have underlying coronary disease may become ischemic from coronary steal. Rhythm can degenerate and lead to [[VF]] that cannot be resuscitated. Furthermore, some [[VT]] (esp those with structurally normal hearts) are [[adenosine]] responsive and can terminate. | ||
*:# Etiology Uncertain | *:# Etiology Uncertain | ||
*:#:* [[Pronestyl]] | *:#:* [[Pronestyl]] 15 mg/kg load over 30 minutes then 2-6 mg/min gtt | ||
*:# [[Ventricular Tachycardia]] with active ischemia | *:# [[Ventricular Tachycardia]] with active ischemia | ||
*:#:* [[Lidocaine]] 1 mg/kg q5-10 min up to 3 times then 2- | *:#:* [[Lidocaine]] 1 mg/kg q5-10 min up to 3 times then 2-6 mg/min gtt | ||
*:#:* If unsuccessful, [[Pronestyl]] as above | *:#:* If unsuccessful, [[Pronestyl]] as above | ||
*:#:* If unsuccessful, IV [[Amiodarone]] 150-300 load over 15- | *:#:* If unsuccessful, IV [[Amiodarone]] 150-300 load over 15-20 min. 30-60 mg/hr gtt for total of 1 gram | ||
*:# [[Ventricular Tachycardia]] in Setting of [[Cardiomyopathy]] | *:# [[Ventricular Tachycardia]] in Setting of [[Cardiomyopathy]] | ||
*:#:* Skip [[Lidocaine]] and go straight to [[Pronestyl]] | *:#:* Skip [[Lidocaine]] and go straight to [[Pronestyl]] | ||
*:# Positively [[SVT]] with aberrancy | *:# Positively [[SVT]] with aberrancy | ||
*:#:* [[Adenosine]] 6mg rapid IV bolus in large vein. May repeat with | *:#:* [[Adenosine]] 6mg rapid IV bolus in large vein. May repeat with 12 mg x2. | ||
*:#:* [[Lopressor]] 2.5-5. | *:#:* [[Lopressor]] 2.5-5.0 mg IV | ||
*:#:* [[Diltiazem]] 10- | *:#:* [[Diltiazem]] 10-20 mg bolus followed by gtt 5-20 mg/hr | ||
*:#:* [[Verapamil]] 2.5-5. | *:#:* [[Verapamil]] 2.5-5.0 mg bolus. | ||
*:#:* Avoid [[Digoxin]]. Takes too long to work and can be proarrhythmic | *:#:* Avoid [[Digoxin]]. Takes too long to work and can be proarrhythmic | ||
*:#:* [[Pronestyl]] as above | *:#:* [[Pronestyl]] as above |
Revision as of 16:44, 8 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Medical Therapy
- If stable: (More patients than you think)
- Do not use Ca2+ Channel blocker, Digoxin or Adenosine if you don't not know the etiology of the Wide Complex Tachycardia. Ca2+ Channel blockers and Digoxin can lead to accelerated conduction down a bypass tract and VF.
- Though ACLS guidelines recommend a diagnostic trial of Adenosine, it can precipitate VF in some patients with SVT. Patients who have underlying coronary disease may become ischemic from coronary steal. Rhythm can degenerate and lead to VF that cannot be resuscitated. Furthermore, some VT (esp those with structurally normal hearts) are adenosine responsive and can terminate.
- Etiology Uncertain
- Pronestyl 15 mg/kg load over 30 minutes then 2-6 mg/min gtt
- Ventricular Tachycardia with active ischemia
- Lidocaine 1 mg/kg q5-10 min up to 3 times then 2-6 mg/min gtt
- If unsuccessful, Pronestyl as above
- If unsuccessful, IV Amiodarone 150-300 load over 15-20 min. 30-60 mg/hr gtt for total of 1 gram
- Ventricular Tachycardia in Setting of Cardiomyopathy
- Positively SVT with aberrancy
- Antidromic AVRT
- Etiology Uncertain
Defibrillation
Indications for defibrillation include the following:
- Chest pain
- Congestive heart failure (CHF)
- Hypotension with symptoms
- Loss of consciousness
- Seizure