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Author: Blake Briggs, MD
Objectives: approach to tachyarrhythmias, their EKG features, treatments, and complications
Stable vs Unstable
-the most important step. Determines treatment, disposition.
1- Stable vs unstable?
2- P waves present?
3- Regular or irregular?
4- QRS wide or narrow (<3 small boxes)?
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Sinus tachycardia is NOT included in this discussion today as it is considered an “appropriate” response to some pathology. One should address underlying causes (infection, trauma, PE, etc).
Today in a general nutshell: Stable = meds first Unstable = shock first
Heart rates >140 are generally considered to be pathologic as this is when cardiac output begins to decrease.
1) Stable vs unstable: Assess ABC’s (protecting airway and verbalizing, breathing, BP >90)
2) P waves? Initial step to determine if sinus rhythm or not. Rate?
a. Must be upright and in every lead.
3) Wide or narrow?
a. Narrow = above the AV node (atrial origin)
b. Wide = below the AV node (BBB, Purkinje system, ventricular myocytes)
4) Regular or irregular?
a. Regular = predictable rhythm.
b. Irregular = rhythm is not predictable due to electricity coming in variable responses from the SA node.