Torsades de Pointes (Deep Dive R21)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 15 May 2021

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Torsades de Pointes (TdP)

A type of polymorphic ventricular tachycardia that is inherently unstable and often quickly degrades into ventricular fibrillation. It usually occurs in the setting of a prolonged QT interval, which can either be genetic or acquired.

Treatment

* Defibrillation – per ACLS, ventricular tachycardia with a pulse should receive synchronized cardioversion. But in real life, the defibrillator often isn’t able to “sync” with TdP, forcing you to perform unsynchronized cardioversion (aka defibrillation).* IV Magnesium – treats and prevents TdP, even when magnesium levels are normal* Overdrive Pacing – by preventing bradycardia, we help prevent TdP (bradycardia prolongs the QT interval). * Electrical Overdrive Pacing – transcutaneous or transvenous pacemaker* Chemical Overdrive Pacing – beta agonist therapy (isoproterenol)* Lidocaine – anti-arrhythmic therapy that does not prolong QTc.* Fix underlying cause – congenital long QT syndrome, hypokalemia, hypocalcemia, medication induced (psych meds, anti-emetics, methadone, fluoroquinolones, many more)

Defibrillation and IV Magnesium are used for patients who are ACTIVELY in TdP. Once you shock/mag them into a stable rhythm, you can use Overdrive Pacing / Lidocaine / Treat Underlying Cause to PREVENT them from going back into TdP.

Transcript

Click on a timestamp to play from that location

0:00.0	Hello, med students. My name is Zach Olson, and thank you for downloading this episode of the EM
0:06.6	Clerkship podcast. This episode is sponsored by Pearson Ravits Insurance. Stephanie Pearson at Pearson
0:14.4	Ravits is my personal disability and life insurance agent. She is an OBGYN who became injured while at work and now runs an insurance company that
0:23.6	advocates for and educates medical professionals on insurance-related issues, things like
0:28.9	disability insurance.
0:30.7	She will walk you through what it means to have own occupation insurance.
0:34.9	She'll shop around the major insurance companies for you, not just comparing costs, but comparing
0:39.6	features, pros and cons.
0:42.0	She coordinates everything for you and you finally decide to buy and then proactively
0:45.5	gets in touch with you every year to see how things are going.
0:48.4	It really is a remarkable company.
0:50.5	Don't wait until it's too late.
0:52.2	Don't wait until the policy becomes really expensive. Don't wait until you have too late. Don't wait until the policy becomes really expensive.
0:55.1	Don't wait until you have medical conditions that are excluded.
0:58.6	Don't wait until something happens.
1:00.9	You need to buy this stuff during training.
1:03.4	Go to www.personravits.com.
1:07.9	Get in touch and they're going to hook you up.
1:09.7	Thank you to Pearson Rabbits for sponsoring this episode.
1:12.9	Now on to our deep dive.
1:14.8	So this last case was a true classic.
1:19.1	Torsad de point.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.