ACLS review: Wide Complex Tachycardia (WCT) Part 5

Stable Wide Complex Tachycardia

·         Adenosine

·         Procainamide

·         Sotalol

·         Amiodarone

·         Cardioversion

Note:  For patients who are stable with likely VT, IV antiarrhythmic drugs or elective cardioversion is the preferred treatment strategy. If IV antiarrhythmics are administered, procainamide (Class IIa, LOE B), amiodarone (Class IIb, LOE B), or sotalol (Class IIb, LOE B) can be considered

Adenosine

·         6mg rapid IV over 2-3sec.                                                                   

·         Repeat Adenosine at 12mg rapid IV over 2-3sec.

·         Repeat Adenosine at 12mg rapid IV over 2-3sec.

·         Reduce dosage in patients using Tegretol or dipyridamole

·         Relatively contraindicated in patient with asthma

 

Note

If the rhythm does not convert within 1 to 2 minutes, give a 12 mg rapid IV push using the method above. The initial dose may be reduced to 3 mg in patients taking dipyridamole or carbamazepine, those with transplanted hearts, or if given by central venous access. Side effects with adenosine are common but transient; flushing, dyspnea, and chest discomfort are the most frequently observed.  Adenosine should not be given to patients with asthma.

 

Adenosine

·         Adenosine should be considered for stable monomorphic, regular wide complex tachycardia

·         Adenosine should not be used for irregular wide complex tachycardia

 

Pause after Adenosine

Cardioversion with
 Adensoine

Reviewed 2/28/16