ACLS review: Wide Complex Tachycardia (WCT) Part 2

Symptomatic Tachycardia

·         Symptomatic implies that an arrhythmia is causing symptoms, such as palpitations, lightheadedness, or dyspnea, but the patient is stable and not in imminent danger.

·         In such cases more time is available to decide on the most appropriate intervention

Unstable Tachycardia

·         Refers to a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent.

·         When an arrhythmia causes a patient to be unstable, immediate intervention is indicated

Symptoms of Instability

·         Chest pain

·         Syncope

·         Shortness of breath

·         Cold and clammy skin

·         Decreased level of consciousness

·         Hypotension

·         Pulmonary congestion

Note:  If the tachycardic patient is unstable with severe signs and symptoms related to a suspected arrhythmia (eg, acute altered mental status, ischemic chest discomfort, acute heart failure, hypotension, or other signs of shock), immediate cardioversion should be performed (with prior sedation in the conscious patient)

Evaluate Rhythm

·         Obtain 12 lead EKG

·         Determine if QRS complex is ≥0.12 seconds

·         Determine if rhythm is regular

·         Determine treatment options

·         Consider expert consultation

Note:  If the patient with tachycardia is stable, determine if the patient has a narrow-complex or wide-complex tachycardia, whether the rhythm is regular or irregular, and for wide complexes whether the QRS morphology is monomorphic or polymorphic. Therapy is then tailored accordingly

Stable patients may await expert consultation because treatment has the potential for harm.

Reviewed 2/28/16