HWN Suggests

ED Guide to Ventricular Tachycardia: Positively Shocking

A much more reliable method is that anyone with any ischemic heart disease history, heart failure, or just being elderly has about a 98% chance that the wide regular complex tachycardia you see is VT. Additionally, those <40 years old still have up to a 50% occurrence of VT on EKGs compared to SVT with aberrancy.

So, bottom line, vast majority of wide complex tachycardia is VT. Treat for VT, sort it out later. VT is the rhythm that will kill your patient first, not SVT with aberrancy!

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  The Current State of Refractory VF

Given the difficulty in converting RVF to a perfusing rhythm, here are a few strategies beyond the standard therapy to add to your toolbox.

 First-Line Treatment for Ventricular Tachycardia? What the Guidelines and Evidence Say

You push 6 mg, but the rhythm does not revert to sinus or uncover P waves. You push 12 mg, and again, no effect. At this point, you decide that this may be stable VT. You treat with Procainamide 1 gm infusion over 30 minutes, and after 15 minutes, the rhythm reverts to normal sinus rhythm.

 Refractory Ventricular Tachycardia: Approach to Management

Refractory ventricular tachycardia, also known as “electrical storm,” is defined as at least two or more separate ventricular tachycardia (VT) or fibrillation (VF) episodes requiring intervention in a 24-hour period.

Articles of Interest

Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion

\Wide & regular = ventricular tachycardia until proven otherwise.

Monomorphic VT storm

Generally defined as three or more episodes of VF or sustained VT requiring intervention (e.g., defibrillation or ICD shocks) within 24 hours.

Ventricular Tachycardia Mimics

VT is an important cause of wide complex tachycardia. In all patients presenting with wide complex tachycardia, emergency physicians should consider mimics of VT as a part of the evaluation with the caveat, however, that differentiating between the causes of a wide complex tachycardia can be difficult in a time-sensitive situation.