Wide Complex Tachycardia WITH Pulse

Question 1

A patient presents with UNSTABLE wide complex tachycardia. What are the appropriate steps?

Answer 1

1. LOC
2. Circulation
3. Airway - open and clear
4. Breathing - (need assistance?)
5. IV, O2, Monitors
6. CARDIOVERT 120-150-200
7. Procainamide - 20 mg/min
8. Amiodarone - 150mg X 3 (Q3-5mins)
9. Sotolol - 100mg
10. Expert consultation

Question 2

A patient presents with STABLE wide complex tachycardia. What are the appropriate steps?

Answer 2

1. LOC
2. Circulation
3. Airway - open and clear
4. Breathing - (need assistance?)
5. IV, O2, Monitors
6. VAGAL MANEUVER
7. Procainamide - 20 mg/min
8. Amiodarone - 150mg X 3 (Q3-5mins)
9. Sotolol - 100mg
10. Expert consultation

Question 3

Cardioversion is synchronized or unsynchronized for wide complex tachycardia with a pulse?

Answer 3

Synchronized

Question 4

what is the underlying pathophysiology of unstable tachycardia that causes symptoms?

Answer 4

HR increased to the point that Cardiac Output is reduced

Question 5

HR >___ are usually symptomatic and require cardioversion?

Answer 5

HR >150bpm

Question 6

When are SYNCHRONIZED shocks recommended?

Answer 6

• unstable SVT
• unstable atrial fibrillation
• unstable atrial flutter
• unstable regular monomorphic tachycardia with pulse

Question 7

When are UNSYNCHRONIZED shocks recommended?

Answer 7

• pulseless V-tach or V-fib
• patient demonstrating clinical deterioration
• if you’re unsure if VT is monomorphic or polymorphic in the unstable patient