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Wide Complex Tachycardia Changing to VT.    These three consecutive pages are on the same patient.  The patient had an underlying wide QRS complex.  You can see a transition in the morphology of the QRS complexes.  This was enough to suggest VT.      

Wide Complex Tachycardia.  The pages are on the same pages.  The first page shows the underlying sinus rhythm so you can evaluate the QRS complexes.  The second page shows the same patient with a faster heart rate, around 150 bpm  The morphology of the QRS complexes is the same as the underlying rhythm seen on the first page.  Without knowing the underlying rhythm it would be easy to confuse the fast rhythm for VT.  

Wide complex tachycardia changing to sinus bradycardia  

The rhythm is irregular.  No P waves are seen.  Some fibrillation is seen between some of the QRS complexes. The QRS complexes are wide.  

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Atrial fibrillation with slow ventricular response The rhythm is irregular with a ventricular rate of 50/min.   No P waves are seen but there is fibrillatory activity between the QRS complexes.   No ectopic beats are seen.   PR:  ---,  QRS:  .08 sec,  QT:  .42 sec. 2. NSR with ventricular bigeminy The rhythm is irregular with a rate of 70/min.   The P waves are upright, uniform, and paired with a QRS complex.   There are PVCs every other beat.   PR:  .20 sec,  QRS:  .12 sec,  QT: .44 sec 3. Atrial fibrillation with ventricular demand pacing and a PVC The rhythm is irregular.   The rate is 70/min.   No P waves are present.   There is a single PVC present, the 5th complex.   The 1st and 6th complexes are ventricular paced beats while the remaining complexes are the patient...

The Effects of Epinephrine During a Pulseless Arrest  Drug Therapy: Epinephrine ·          Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min ·          ETT dose (1:1000 solution) 2mg diluted in 10cc of NS ·          Increases systemic vascular resistance (vasoconstriction) ·          Increase coronary and cerebral perfusion pressures during CPR ·          Escalating or high doses without demonstrable benefit ·          After drug delivery and approximately 5 cycles (or about 2 minutes) of CPR then recheck the rhythm  Algorithms  and dosages ·         Pulseless VF/VT   Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min ·     Asystole:   Epinephrine 1mg (1:10,000 solution) I...

31.   What are two critical determinations that must be assessed in the management of symptomatic tachycardia? 32. What is the difference in the way symptomatic monomorphic VT and polymorphic VT is treated? 33.   What is the difference between synchronized cardioversion and defibrillation? 34.   What two tachycardic rhythms will not usually respond to synchronized cardioversion? 35. What are three potential problems associated with synchronized cardioversion? 36.   What are three examples of wide complex tachycardia? 37.   In what circumstances would you consider changing your initial dose of Adenosine? 38.   What are two initial interventions in the treatment of wide complex tachycardias? 39.   After delivering a synchronized shock to a patient you notice that the patient’s heart rhythm changes to VF.   What would you do? 40.   What is the cardinal rule for evaluating wide complex tachycardia? Answ...

21.   Explain the technique for performing a Valsalva maneuverer. 22.   What are some contraindications for performing carotid sinus massage? 23.   Cardioversion has been shown to be ineffective in the treatment of what two rhythms? 24.   What is synchronized cardioversion?   25.   What are some examples of wide complex tachycardia (QRS >0.12 second)? 26.   Explain how vagal maneuvers and adenosine may aid in the correct identification of a tachyarrhythmia. 27. What should the health care provider do if the patient fails to respond to an initial dose of adenosine?   28. If a patient in symptomatic wide complex tachycardia fails to respond to adenosine, what beta blocker can be used? 29. What are some signs and symptoms of unstable wide complex tachycardia? 30.   What are four initial interventions that are used in the treatment of symptomatic wide complex tachycardia? Answers 21.   Explain the...

11. What are 5 vagal maneuvers that can be used in the initial treatment of wide complex tachycardia? 12. What is the initial dose Adenosine when treating an adult in wide complex tachycardia? 13. When using a monophasic defibrillator, what is the initial joule setting used to cardiovert an adult with wide complex tachycardia? 14. During the treatment of refractory wide complex tachycardia, what is the second dose of adenosine? 15. What are some conditions that may predispose a patient to torsades de pointes? 16. Name three antiarrhythmics that can be used to treat stable VT? 17. What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse? 18.   Name 5 precautions that should be considered prior to performing carotid sinus massage? 19.   An adult patient in unstable wide complex tachycardia does not respond to an initial cardioversion attempt at 100 J.   What would the next step be in the treatment of this...

1.   What are the ECG characteristics of Torsades de pointes? 2. Magnesium is the drug of choice in the treatment of what dysrhythmia? 3.   What is the dose of Procainamide used in the treatment of VT with a pulse? 4. What is the initial joule setting when performing cardioversion on a patient with monomorphic VT? 5.   What are four differences between defibrillation and cardioversion? 6. What is the initial dosage of Lidocaine used in the treatment of wide complex tachycardia? 7.   What is the initial joule setting when delivering a synchronized shock to an adult victim in unstable SVT with aberrancy? 8.   What is the maximum cumulative dosage of Lidocaine that is recommended during the treatment of stable VT? 9.   What is the dosage of magnesium used in the treatment of torsade de pointe? 10.   Adenosine is indicated in the treatment of what arrhythmias? Answers 1.   What are the ECG characteristics ...

Torsades de pointes Torsades de pointes Torsades de pointes ·          Occurs in a setting of bradycardia and prolongation of the QT interval. ·          A continuously changing VT morphology is often described as appearing to rotate or turn around the ECG baseline. ·          Polymorphic VT, including torsades, frequently terminates, but the arrhythmia will recur and seldom remains stable. ·          should be treated immediately because of the frequent transition to unstable VT Note :  If a long QT interval is observed during sinus rhythm (ie, the VT is torsades de pointes), the first step is to stop medications known to prolong the QT interval. Correct electrolyte imbalance and other acute precipitants Treatment of Torsades de Pointes ·        ...

Polymorphic VT Polymorphic VT ·          varying QRS morphology ·          irregular rhythm ·          hemodynamically unstable ·          should be treated immediately because of the frequent transition to unstable VT ·          often associated with ischemic heart events or electrolyte or toxic conditions Treatment ·          Assess QT baseline ·          If normal use: o    Procainamide o    Amiodarone o    Sotalol o    Unsynchronized Cardioversion Note:   Adenosine should not be given for unstable or for irregular or polymorphic wide complex tachycardias, as it may cause degeneration of the Arrhythmia to VF (Class...