Ventricular Tachycardia should not exceed 200ms. A QRS this wide, exhibiting Sine Wave, you should be suspect Tox or Metabolic! This patient was septic with hyperkalemia! Standard ACLS will not save this patient! Avoid Amiodarone, Lidocaine, & Procainamide! Hyperkalemia is basically sodium poisoning, so you'll get the same result giving any of these. Bicarb & Calcium! Treatment is similar to TCA OD!
Sodium Bicarbonate & Calcium!
ReplyDeleteIn EMS, we typically only carry Calcium Chloride, which is very irritating to the vein, and should only be administered via a central line. Another accessible and immediate pre-hospital treatment is Albuterol. One study demonstrated a drop in potassium for 5.6 o 4.5 in 30 minutes. (Arch Intern Med 1987;147:713-717)
Delete"How do you avoid a clean kill with wide complex tachycardias?" Refer to Dr. Amal Attu's youtube lecture. He's an amazing emergency room physician! Amazing insight!
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