Next week I’ll be re-certifying in Basic Life Support and in Advanced Cardiac Life Support. In addition to reviewing all the course materials before the courses, I like to review additional resources.
Today I reviewed Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion from Emergency Medicine Cases. I listened to the podcast and reviewed the show notes.
Note to myself: The show notes are outstanding and need to be reviewed in their entirety. They are simply the best resource on tachyarrythmias I’ve ever read.
And be sure to review:
(1) Pre-excitation Syndromes from Life In The Fast Lane
by Dr Ed Burns, last update November 25, 2018.
(2) Management Of Unstable Atrial Fibrillation In The Emergency In The Emergency Department by Dr Justin Morgenstern from First10EM. Posted on December 7, 2015
Here are some excerpts from Episode 112:
General Approach to Tachydysrhythmias
Asking these three questions will help classify any tachydysrhythmia in most cases.
- Regular or irregular?
- Narrow or wide QRS?
- Are there P waves? P-QRS relationship? How many P waves for each QRS?
Ventricular Tachycardia (VT) vs SVT with aberrancy: Assume VT
Wide & regular = ventricular tachycardia until proven otherwise. Clinical stability does not differentiate between VT and SVT with aberrancy.
Remember that although advanced age makes a wide complex tachycardia VT much more likely than SVT with aberrancy, up to 50% of patients under 40 years of age who present with a wide complex regular tachycardia with have VT. In addition, response to adenosine does not rule out VT.
As per ACLS guidelines, If any tachydysrhythmia presents as unstable, the treatment of choice is synchronized electrical cardioversion.
Pitfall: Mistaking AIVR (post-lytics for STEMI) for VT and treating with lidocaine may cause cardiovascular collapse. [In the podcast the speaker states that the rate is less than 120 – what we used to call slow vt.]
Additional Resources
(1) Pre-excitation Syndromes from Life In The Fast Lane
by Dr Ed Burns, last update November 25, 2018.
(2) Management Of Unstable Atrial Fibrillation In The Emergency In The Emergency Department by Dr Justin Morgenstern from First10EM. Posted on December 7, 2015
