WCT
For stable, regular WCT, it is reasonable to treat with adenosine first. If adenosine does not terminate the stable WCT, assume VT and consider drug treatment. Use synchronized cardioversion for the unstable patient - Rithvik Balakrishnan MD
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Extremely Fast & Wide Complex Regular Tachycardia
Most wide complex regular tachycardias are ventricular tachycardia (VT). However, supraventricular tachycardias can also cause wide complexes through aberrant conduction and accessory pathways.
The exact diagnosis of a tachydysrhythmia is often irrelevant in the ED management of unstable patients. Clinical stability is a more important determinant of treatment than the underlying rhythm.
Resources
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.
Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion
Remember that although advanced age makes a wide complex tachycardia VT much more likely than SVT with aberrancy, up to 50% of patients under 40 years of age who present with a wide complex regular tachycardia with have VT. In addition, response to adenosine does not rule out VT.
Irregular Wide Complex Tachycardia: Vtach?
Consider WPW with Afib in any Fast, Broad, Irregular (FBI) rhythm without signs of BBB pattern, especially if rate is excessive (>180).
Extremely Fast & Wide Complex Regular Tachycardia
The exact diagnosis of a tachydysrhythmia is often irrelevant in the ED management of unstable patients. Clinical stability is a more important determinant of treatment than the underlying rhythm.
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