Thread by @MRamzyDO, Summer means new Interns! Since everyones heart may be racing a bit, [...]

Summer means new Interns! Since everyones heart may be racing a bit, heres a non #COVID19 thread about some tachycardias w/three take away points!

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“Patient Stability” is a general & broad term that some argue has a lot of grey area. Generally, it refers to hemodynamics (ie. SpO2, HR and BP) responsible for important organ perfusion

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Always clinically assess patients for instability. Go through the ABCs before the H+P. Look at their mental status, vitals, etc as this will guide your treatment of their arrhythmia

@HippoEducation @CORD_EM @EMFundamentals @FoundationsEM @EMBoardBombs @purdy_eve @iem_student

1st Take away point when treating tachycardia (& every patient (in #EmergencyMedicine)) = Determine if clinically stable or unstable!

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Before going any further, let’s first understand some important terms and definitions that will be part of our discussion

When a patient comes in with a HR above 200s, its important to differentiate the types of pre-excitation syndromes. @Precordialthump, @sandnsurf & @edjamesburns have a great post here on @LITFL

https://litfl.com/pre-excitation-syndromes-ecg-library/

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Another critical clinical distinction that needs to be made is differentiating V-Tach from SVT w/Aberrancy. One can use Brugada’s criteria to help better identify VT

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REBEL EM has a great post about differentiating VT from SVT w/Aberrancy found here:

https://rebelem.com/svt-aberrancy-versus-vt/ via @srrezaie & @EMSwami

So 2nd take away point: Use Brugada’s Criteria to help differentiate VT from SVT w/Aberrancy!

When talking about treatment, antiarrhythmics can be confusing and complicated. Thankfully @RxKeySlides created this awesome infographic to visually help simplify each drug’s effect on the cardiac action potential!

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A frequently debated topic is the treatment of stable wide complex tachycardia. Although a small study, the PROCAMIO trial showed procainamide has less major cardiac adverse events than amiodarone:
https://rebelem.com/rebelcast-procamio/ via @srrezaie

Lets finish this off with a patient case. This 70s male presented with light-headedness, generalized weakness & SBP in the mid 90s. (Known by cardiology to have slightly low BP)

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Following failed AICD overdrive pacing, 100 mg of Procainamide was given over 2 minutes four times before being placed on a procainamide gtt. He reported feeling better after the boluses and here’s his EKG:

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This leads us to the 3rd & final teaching point: Consider Procainamide for stable patients in wide complex tachycardia.

Heres the #summary of the three teaching points and thanks for reading!

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