Management of Broad complex tachycardia

Management of Broad complex tachycardia

Give high-flow O2 by mask and monitor O2 saturations.
Connect patient to a cardiac monitor and have a defibrillator to hand.
Correct electrolyte abnormalities.
Check for adverse signs. Low cardiac output (clammy, consciousness↓, BP <90); oliguria; angina; pulmonary oedema.
Obtain 12-lead ECG (request CXR) and obtain IV access.

If haemodynamically unstable
Synchronized DC shock (see Resuscitation Guidelines inside back cover).
Correct any hypokalaemia and hypomagnesaemia: 60mmol KCl at 30mmol/h, and 5mL 50% magnesium sulphate over 30min).
Follow with amiodarone 300mg IV over 20-60min.
For refractory cases procainamide or sotalol may be considered.

If haemodynamically stable
Correct hypokalaemia and hypomagnesaemia: as above.
Amiodarone 300mg IV over 20-60 min. Alternatively lidocaine 50mg (2.5mL of 2% solution) IV over 2min, repeated every 5min up to 200mg.
If this fails, use synchronized DC shock.

After correction of VT
Establish the cause (via the history and tests above)
Maintenance anti-arrhythmic therapy may be required. If VT occurs after MI, give IV amiodarone or lidocaine infusion for 12-24h; if 24h after MI, also start oral anti-arrhythmic: sotalol (if good LV function) or amiodarone (if poor LV function).
Prevention of recurrent VT: surgical isolation of the arrhythmogenic area or implantation of tiny automatic defibrillators may help.

Ventricular fibrillation
(ECG) Use non-synchronized DC shock (there is no R wave to trigger defibrillation,

Ventricular extrasystoles (ectopics)
are the commonest post-MI arrhythmia but they are also seen in healthy people (often >10/h). Patients with frequent ectopics post-MI have a worse prognosis, but there is no evidence that antidysrhythmic drugs improve outcome, indeed they may increase mortality.