VT

Look more carefully, its broad complex

Noted Dr, it's VT, but is there narrow complex only in lead aVL?

Would like to try🙋🏻‍♀️ :

Vtach - check pulse
If pulseless vtach- defib and stabilise patient
If theres pulse -stabilise patient and give (anti-arrhythmic meds like amiodarone)

VT
Mx: 
1. If pulseless vt, then proceed with defib, cpr, oxygen, adrenaline, amiodarone
3. If vt with presence of pulse & patient is unstable, treat with synchronized cardioversion

monomorphic VT

Mx :
1. Pulseless VT - CPR w BMV. VS monitoring. Defib. IV epi every 3-5 mins. After ROSC, consider invasive ventilation.
2. Pulse VT
- stable? consider antiarrythmic like amiodarone or sotalol if monomorphic VT
- unstable (hypotension, shock, confusion, IHD) - synchronized cardioversion + iv morphine and midazolam.

Mx
1. Check if patient is collapse or pulseless
2. Prepare a cardiac monitor, Oxygen, Defibrillator, IV cannula, Drug (Adrenaline, Amiodarone)
3. If Patient is Pulseless, CPR with Manual Bagging for 2 minutes , then reassess with Defib, and repeat Defib if no response, and give Adrenaline and Amiodarone after 2nd and 3rd Defib respectively.
4. If patient is pulsed yet unstable, do synchronised cardioversion under sedation like strong Opiods and benzodiazepines (Mida)
5. If patient is pulsed and stable, give IV Amiodarone and then Oral Amiodarone

Unstable signs are:-
a. Tachycardia
b. Cold Periphery, Poor Perfusion
c. Hypotension
d. Giddiness , Syncopes
e. Ischemic chest pain
f. Heart failure with Pulmonary edema

Very helpful,tq

Monomorphic VT. As it is broad complex, it originates from ventricular ectopic focus(below bundle of His). Narrow complex would originate above bundle of His which can be seen in SVT, afib, aflutter. Polymorphic VT usually associates with torsades de pointes (which precipitated by QT prolongation)

Management

A. VT with Pulse
1. Unstable patient (systolic <90, severe heart failure, myocardial ischaemia, syncope), give synchronised DC up to 3 attempts with IV morphine and midazolam, if unsuccessful, consider giving IV amiodarone 300mg over 10-20 mins and repeat synchronised DC

2. Stable patient, give amiodarone (IV 150mg over 10 min) or IV lidocaine or IV procainamide, if persist, consider urgent synchronised DC up to 3 attempts with IV morphine and midazolam

B. Pulseless VT
- Defib, Cpr for 2 mins, reassess, give IV/IO epinephrine 1mg every 3-5 mins after 2nd shock and IV/IO amiodarone (300mg bolus for 1st dose and 150mg for 2nd dose) after 3rd shock, then look for rosc. If there is rosc, go for post cardiac arrest care
- Identify and treat reversible causes (5H 5T)
- remember to give high quality cpr