STAT ECG Diagnoses: a review of the differentials to consider when dealing with wide complex tachycardias and when antiarrhythmic medications can be harmful
ECG Weekly Workout with Dr. Amal Mattu
HPI
A 41-year-old female is brought into the ED by EMS unresponsive with unknown past medical history. She is found to be febrile, normotensive (126/78), tachycardic (120s-150s), tachypneic (30s with a Kussmaul respiratory pattern), SpO2 = 98% on room air, and POC glucose = “high”. The following ECG is obtained that shows a wide complex tachycardia:
The patient is treated empirically with calcium and insulin for suspected hyperkalemia, but there is no effect after 2 rounds of treatment.
- What is your differential for this wide complex tachycardia?
- Do you suspect ventricular tachycardia?
- Would you treat with an antiarrhythmic medication (amiodarone, lidocaine, procainamide, etc.)?