Approach to the Patient with Irregular Broad Complex Tachycardia

Approach to the Patient with Irregular Broad Complex Tachycardia - Flowchart Approach to the Patient with Irregular Broad Complex Tachycardia Approach to the Patient with Irregular Broad Complex Tachycardia

Flowchart

See Chapter 39 for general approach to the patient with an arrhythmia

End

Irregular broad complex tachycardia

Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Focused assessment (Table 39.1)

Table 1.1

Table 39.1

12-lead ECG and rhythm strip (Table 41.1)
Check electrolytes/creatinine

Table 41.1

Stabilize airway and breathing
Call resuscitation team
DC cardioversion
Refer to cardiologist

Patient unstable?

Yes

No action needed

ECG abnormality due to artifact (pseudoventricular tachycardia)? (Fig. 40.3, Table 41.1)

Fig. 40.3 Table 41.1

Yes

Atrial fibrillation (AF) with bundle branch block or pre-excited AF

DC or chemical cardioversion (Table 41.3)
Refer to cardiologist

Atrial fibrillation (AF) with bundle branch block or pre-excited AF

DC or chemical cardioversion (Table 41.3)
Refer to cardiologist

Atrial fibrillation (AF) with bundle branch block or pre-excited AF

DC or chemical cardioversion (Table 41.3)
Refer to cardiologist

DC or chemical cardioversion (Table 41.3) Table 41.3
Refer to cardiologist

Treat as polymorphic ventricular tachycardia (Table 41.1)

Table 41.1

ECG consistent with atrial fibrillation (AF)? (Table 41.1)

Table 41.1

Yes

DC or chemical cardioversion (Table 41.2)
If evidence of myocardial ischaemia, manage as acute coronary syndrome (Chapters 45 and 46)
Refer to a cardiologist

DC or chemical cardioversion (Table 41.2) Table 41.2
If evidence of myocardial ischaemia, manage as acute coronary syndrome (Chapters 45 and 46)
Refer to a cardiologist

Stop drugs which may prolong QT interval
Correct hypokalaemia (Chapter 86)
Temporary pacing (Chapter 119) if bradycardia/atrioventricular (AV) block
Refer to a cardiologist

Stop drugs which may prolong QT interval
Correct hypokalaemia (Chapter 86) Chapter 86
Temporary pacing (Chapter 119) if bradycardia/atrioventricular (AV) block Chapter 119
Refer to a cardiologist

QT prolongation before ventricular tachycardia (VT)?

Yes

No/unknown