ACLS review: Wide Complex Tachycardia (WCT) Part 1

Management of Wide Complex Tachycardia (WCT)

Ventricular tachycardia

·         Rate: The atrial rate can't be determined. The ventricular rate is 150 - 250. If the rate is under 150, it is called a slow VT.

·         Rhythm: The rhythm is most often regular.

·         P Wave: Not usually visible.

·         QRS: The QRS is bizarre and wide, 0.12 or greater.

·         T Waves: Difficult to differentiate T waves from QRS complexes

Wide complex tachycardia

 

Mnemonic for Treating WCT:  PREVADE

·         Primary Survey

·         Recognize if the patient is stable or unstable

·         Evaluate rhythm- EKG

·         Vagal Maneuvers

·         Adenosine & antiarrhythmics

·         Direct cardioversion

·         Expert consultation

Primary Survey- ABCs

·         Airway- supplemental oxygen

·         Breathing

·         Circulation

o    Check VS

o    Assess pulse

o    Attach defibrillator/monitor

o    12 lead EKG

Note:  Because hypoxemia is a common cause of tachycardia, initial evaluation of any patient with tachycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry

Recognize if the Patient is Stable or Unstable

·         Evaluate the patient: symptomatic or unstable

·         Identify potential reversible causes of the tachycardia

Note:  Many experts suggest that when a heart rate is <150 beats per minute, it is unlikely that symptoms of instability are caused primarily by the tachycardia unless there is impaired ventricular function.


Reviewed 2/28/16