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Approac

SVT - VT VF Torsa Tachyarrhyth

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basicanatom

y

conductinsystem

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7/24/2019 Approach to Tachy

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A 52 years oldgentleman, !" #M acame to $SM 'complaints o( palpita

S)* (or last 2 hour+ patient loo tachypneic and 'as a'ay push to red .

'hat you/re gonna d

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Management Appro

Assess

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Assess, clear and support A*s

Supplemental )0ygen

V access

Attach de3brillator!&4 monitor and assess rhythm

Tachycardia 6788bpm

9ide comple0: ;ailable

"oo (or serious sign and symptom ?$ypotension, A

mental status, S)*, schemic chest pain, Acute hea

Management Appro

7/24/2019 Approach to Tachy

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4eneral approach $eart rate1

Additional beats or missing beats1

*road or narro' %arro': AV unction or abo>e

*road: ***, >enricles or accessorypath'ay

ni(orm or multi(orm P 'a>es1

P ;e AV unction+"iely due to sinus or atrial tachycardia

P 6 ;

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Tachycardia

%arro' comple0es

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Supra>entricular Tachycardia ?S

$enin criteria

e Seldom seen due to rapid rate

because p 'a>e hidden in thepreceeding T 'a>es

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%on pharmacological met Vaal manoeuvres

Supine position pre(erred

Possible techniCue *lo' into 28ml syringe

Straining lie

Maintain (or D8 seconds and released a(ter that

%arotid sinus massae %ot in elderly ?atherosclerotic and ris o( stroe@

Ascultate (or carotid bruit

7/24/2019 Approach to Tachy

11/17

hemical cardio>ersion

Adenosine &0plain transient chest discom(ort, Eushing, nausea

ein 'ith D 'ay connector

er mg V push (ollo'ed by 28ml saline Eush

May repeat up to 20 'ith 72mg a(ter 7-2 minutes bet'een attempts

May cause VF, per(ormed in monitored area 'ith a de3brillator a>ailable

Verapamil onstant in(usion 7mg!min, ma0 28mg

#iltia.em onstant in(usion 2+5mg!min, ma0 58mg

G ( patient become unstable at anytime, synchroni.ed electrical cardio>ersbe per(om ?58, 788, 758, 288@

G )nce con>erted, repeat >ital sign and obtain 72-lead &4

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7/24/2019 Approach to Tachy

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$enincriteria

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Polymorphic VT

$enin criteria

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Ventricular 3brillation

$enin criteria

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Torsades #e pointes

$enin criteria

e %on e0istent

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