Tachycardia

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 10 September 2017

⏱️ 11 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Basic Approach

* Step 1: Is this SINUS tachycardia? * P before every QRS? * Treat the underlying condition* Step 2: Is this a NARROW and REGULAR rhythm?* SVT* Treat with vagal maneuvers or adenosine* Another new trend is treating with calcium channel blockers!! * ORTHOdromic Wolf Parkinson White* Treat with adenosine* Atrial flutter with fixed block* Treat with AV blockers (diltiazem)* Slows the heart rate* Step 3: Is this a NARROW and IRREGULAR tachycardia?* Almost always atrial fibrillation* Treat with AV blockers (diltiazem)* Other (less common) diagnoses* Atrial flutter with variable block* Multifocal atrial tachycardia* Step 4: Is this a WIDE and REGULAR tachycardia?* Assume ventricular tachycardia until proven otherwise* Treatment is immediate cardioversion if unstable* May try chemical cardioversion if stable* Procainamide* Amiodarone* Lidocaine* Other diagnoses* ANTIdromic Wolf Parkinson White* Narrow complex tachycardias PLUS aberrancy* Step 5: Is this a WIDE and IRREGULAR tachycardia?* Atrial fibrillation with bundle branch block* Extremely fast and bizarre in appearance? * Consider atrial fibrillation with Wolf Parkinson White

Additional Reading

* Calcium Channel Blockers for Stable SVT (ALiEM)* Atrial Fibrillation in WPW – Pearls and Pitfalls (County EM)

Transcript

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0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
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0:34.1	and you can cancel at any time if you decide it's not right for you.
0:37.9	You can learn more at www.gitfreed.a.i.
0:45.7	Hello, med students. My name is Zach Olson, and thank you for downloading this week's
0:51.4	episode of the EM Clerkship Podcast.
0:57.1	Let's talk EKGs real quick.
0:59.4	When we consider all of the EKGs, we get in the emergency department.
1:05.5	Emergency doctors look for two things, two EKG issues that can kill patients.
1:10.9	The first is signs of ischemia.
1:14.3	ST elevation, ST depression,
1:16.2	inverted T waves, that type of stuff.
1:18.5	And then the other killer that we always look for on EKGs,
1:23.8	in addition to ischemic changes, are dysrhythmias.
1:28.5	And that's our topic this week, tachycardia.
1:35.0	Hey, it's Jack Olson.
1:36.8	Hey, Dr. Olson.
1:37.6	It's Phil over on Amyos 21.
	...

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