I. Differentiating VTach from SVT w/aberrant conduction: see "Electrocardiography"
- Gauge sx
- Consider vagal maneuvers
- Can give adenosine in increasing doses (6mg, 12mg, 18mg)-If the rhythm is an SVT this may slow it down enough to make it distinguishable from VT, and/or result in a conversion to sinus rhythm.NOTE: There is a theoretical risk in a patient with an accessory AV nodal accessory tract (e.g. Wolff-Parkinson-White syndrome) that adenosine might exacerbate the tachycardia and cause the rhythm to deterioriate to VF.
- Further Tx if sure of which WCT it is:
- SVT===>Propanolol, Verapamil
- VT====>Lidocaine (if hemodynamically stable), Defibrillation
- If unsure which type of WCT it is,
- If hemodynamically stable, IV Procaine (caution-will decrease BP)
- If hemodynamically unstable, SHOCK in sync with QRS