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Sunday, September 7, 2014

Casting a Wide Net for Wide Complex Tachycardia 1/2


A 40 yo female is brought into the emergency department. The patient is unresponsive, hypotensive, and tachycardic. EMS providers are assisting ventilations with a bag valve masked and have attempted defibrillation without success. Paramedics state that the patient was somnolent prior to the arrest and has no cardiac history. A 12 lead ECG is obtained upon arrival at the emergency department.

BP:    80/50
P:      150
R:      12/assisted
Spo2: 100% via BVM


What are your thoughts on the 12 lead?

What is your next course of action?



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2 comments:

  1. ChristopherNovember 6, 2014 at 10:57 AM

    WCT @ 170ish, RBBB + right axis + profound terminal R in aVR.

    Would love a history to include evidence of Na-channel blockers / TCA OD. The somnolence gives some credence to the possibility of a TCA OD (or TCA as part of a polypharmacy OD). Bicarb would be a reasonable treatment choice, followed by lidocaine if the electrical storm continues.

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  2. Vince DNovember 7, 2014 at 1:30 AM

    Looks like I'm following you around on this site now Christopher!

    My first though on seeing this EKG was sodium-channel blockade as well.

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