Wide complex tachycardia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Initial assessment of the ABCs (airway, breathing, and circulation) is critical in the management of the patient with wide complex tachycardia. Patients who are [[hemodynamically unstable]] should undergo immediate cardioversion. | Initial assessment of the ABCs (airway, breathing, and circulation) is critical in the management of the patient with wide complex tachycardia. Patients who are [[hemodynamically unstable]] should undergo immediate [[cardioversion]]. '''''Hemodynamic stability does not reliably differentiate [[VT]] from [[SVT]]'''''. Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. This is often a major mistake on the part of clinicians and can lead to inappropriate treatment of [[VT]] as [[SVT]] with poor outcomes. <ref name="pmid4057488">{{cite journal |author=Morady F, Baerman JM, DiCarlo LA, DeBuitleir M, Krol RB, Wahr DW |title=A prevalent misconception regarding wide-complex tachycardias |journal=[[JAMA : the Journal of the American Medical Association]] |volume=254 |issue=19 |pages=2790–2 |year=1985 |month=November |pmid=4057488 |doi= |url=http://jama.jamanetwork.com/article.aspx?volume=254&page=2790 |issn= |accessdate=2013-08-04}}</ref> | ||
== Physical Examination == | == Physical Examination == | ||
Revision as of 21:01, 4 August 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Initial assessment of the ABCs (airway, breathing, and circulation) is critical in the management of the patient with wide complex tachycardia. Patients who are hemodynamically unstable should undergo immediate cardioversion. Hemodynamic stability does not reliably differentiate VT from SVT. Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. This is often a major mistake on the part of clinicians and can lead to inappropriate treatment of VT as SVT with poor outcomes. [1]
Physical Examination
- Vitals should be obtained to assess hemodynamic stability and guide therapy.
- Cannon "a waves" are a manifestation of AV dissociation and suggest VT.
- Carotid sinus massage (CSM)/Valsalva: ST can gradually slow. MAT, AT, flutter, and AF may transiently slow. An AV nodal dependent WCT may terminate. AV dissociation may become more apparent with CSM in VT. VT can terminate with CSM.
References
- ↑ Morady F, Baerman JM, DiCarlo LA, DeBuitleir M, Krol RB, Wahr DW (1985). "A prevalent misconception regarding wide-complex tachycardias". JAMA : the Journal of the American Medical Association. 254 (19): 2790–2. PMID 4057488. Retrieved 2013-08-04. Unknown parameter
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