Day 5 - Ventricular Tachycardia

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Non-Sustained VT (NSVT)

  • Patients are generally asymptomatic and do not need acute management

  • Beta-Blocker can be initiated for frequent NSVT or symptomatic NSVT

    • Metoprolol 50 - 200mg PO BID

    • Carvedilol 12.5 - 50mg PO daily

    • If Beta-Blockers are ineffective or not tolerated - NHCCB (Diltiazem or Verapamil) or Amiodarone can be trialled

  • Keep Mg>1.0, K>4.0

  • Consider out-patient work-up for structural heart disease

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Unstable Monomorphic VT (Run ACLS Protocol)

  • Call a Code Blue

  • Establish IV access - 2 Large Bohr IVs

  • Consult Airway Expert

  • Administer Sedation

    • Propofol + Fentanyl

    • Fentanyl + Midazolam

  • Immediate Shock

    • If pulseless - Defibrillation

    • If weak pulse - Synchronize, Charge Voltage to 100 - 200 J

Stable Monomorphic VT

  • Move to monitored setting

  • Get ECG immediately, cardiac monitors

  • Medication options:

    • If suspicious of SVT with aberrancy - can trial Adenosine 6mg IV x 1 - those with an atrial origin of wide complex tachycardia will have their VT resolve

    • Amiodarone 150mg IV over 10 minutes - if effective, start amiodarone infusion 900mg IV/24 hours

  • Cardiology consultation

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Torsades de Pointes

  • Most commonly seen in individuals with congenital or acquired prolonged QT

Stable Torsades des Pointes

  • Cardiac Monitors

  • Check for Pulse

  • Magnesium Infusion (2g over 15 min)

  • Discontinue QT prolonging drugs

Unstable Torsades de Pointes

  • Call a Code Blue

  • Run ACLS protocol

  • Shock immediately - Defibrillation voltage

The Intern at Work -