Wide Complex Tachycardia

TYPES

VENTRICULAR TACHYCARDIA

  • see separate document

WIDE COMPLEX SVT

  • see VT document for Brugada algorithm

ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR)

  • encountered in an inferior AMI
  • often causes haemodynamic compromise c/o loss of atrial systole

ECG

  • wide QRS with a rate of 60-110/min
  • sinus rhythm is often only slightly slower than the arrhythmia so the dominant rhythm may be intermittent AIVR and sinus
  • fusion beats are therefore common

Management

  • overdrive pacing
  • atropine

VENTRICULAR FIBRILLATION

  • always causes cardiac arrest
  • often have IHD or are having an MI
  • consider: cardiomyopathy, anti-arrhythmics, severe hypoxia and non-synchronised DC cardiovertion

ECG

  • irregular waves of varying morphology and amplitude

Management

  • immediate cardioversion
  • amiodarone

References and Links

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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