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The Internet Book of Critical Care Podcast

IBCC Episode 12 - Torsades De Pointes

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5714 Ratings

🗓️ 21 November 2018

⏱️ 16 minutes

🧾️ Download transcript

Summary

Do those squiggly lines on the ECG monitor have you patient down in the hypotensive dumps? Don't know what to do? Well we have you covered. Identification, common causes and treatment of TDP can all be found in this one podcast.

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome back to the IBCC podcast. I'm here with Adam and we're going to talk about

0:08.9

Torsod's a paw or toward, I don't know how to pronounce that actually.

0:12.0

You're closer to Montreal than I am. Come on. Your French should be better there.

0:16.1

Let's just stick with TDP.

0:17.7

Got it.

0:18.4

Torzot.

0:19.3

Torzod. I like it.

0:22.5

All right, guys, Torsat. So today it's going to be pretty straightforward. This is a little tidbit to keep you tight in that resuscitation mode. So we're

0:28.1

going to cover the diagnosis, your treatment options, and then some pitfalls. Josh, is it polymorphic VT?

0:33.8

Is it congenital? Is it acquired? These things get confusing. If I'm in there in a crashing

0:38.8

patient in front of me, how am I going to approach this? So the first question, if you're looking

0:42.7

at an EKG, I suppose, is it really polymorphic VT or is it something totally different, like

0:47.7

APB with WPW, really coarse ventricular fibrillation, or hypercalimemia with a sineway pattern. I think usually you can generally get a sense of it just by looking at the EKG and kind of

0:57.0

being aware of those different possibilities.

0:59.0

For example, AFID with WPW is going to be like super, super fast.

1:02.0

It has like a specific look to it that's not quite torsati.

1:06.0

And likewise, hypercalemia with a sine wave pattern, it's going to be more broad-based. But I think it's worth at least keeping in mind that simply because something looks like polymorphic vT does not mean

1:14.4

that it's always going to be polymorphic vT. And then once you've kind of determined that something

1:18.2

is polymorphic v.T, the next question is, is that truly torsad, or is it actually non-torzod polymorphic bt. And this is a little tricky, but it's an important distinction

1:27.7

because sometimes people kind of equate polymorphic ventricular tachycardia with Torsad like I just

1:32.8

did. And that's a mistake. So don't fall into the trap. So it comes out to the clincher question here,

1:39.0

doesn't it? Is the QTC or the QT interval normal or prolonged. Exactly.

...

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