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ID:19856277
大小:766.50 KB
页数:58页
时间:2018-10-07
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1、NarrowComplexTachycardiasMoritzHaagerPGY-5ObjectivesDevelopanapproachReviewtreatmentoptionsDispositondecisionsPerspectiveSVTBroadumbrellatermforanytachycardiaoriginatingabovetheventriclesVariableunderlyingmechanismsbutbasicallyoneTxapproachRangesfromphysiologicalpathol
2、ogical,andbenigndangerousOccursinallagegroupsClinicalpresentationfromasymptomaticshock/CHFWhenpresentedwithanundifferentiatedpresentationwithabroadDDxandvariabilityinoutcomeyouneedanAPPROACHWhyshouldwecare?Morbidity&MortalityPatientdiscomfort&anxietySyncopalevents(fal
3、ls)~15%Riskofsuddencardiacdeathw/accessorypathwaydrivenarrhythmiasTachycardia-mediatedcardiomyopathyLVdilatationw/impairedLVfunctionApproachtoTachycardiaStableorunstable?AssessABC’s,O2,IV,monitors,crashcarttobedsideIngeneralifunstable,give’mjuiceNarroworwideQRS?Regularo
4、rirregular?LookatthePwavesRelationshiptoQRSPwaveaxis/ratePwavemorphology(ies)Whatisthetrigger/underlyingcause?Step1:StableorUnstable?Notalwaysblack&whiteContinuumfromstablecompensateddecompensatedshockarrestStabilitydeterminedbybigpicture:Symptoms,signs,&vitalsCardi
5、o-respiratoryreserveAgeCo-morbiditiesBepreparedAnydysrhythmiacouldpotentiallydeteriorateAlltherapiesarepotentiallypro-arrhythmicStep2:Narroworwide?MeasurewidestQRSonECGAdults:wide=>0.12sec(3smallboxes)Kids<8yo:wide=>0.08sec(2boxes)Step3:RegularorIrregular?Usecalipersorp
6、aperIrregularitycanbesubtle,espatfastratesGenerallyIrregularrhythmsoriginateABOVEtheAVnodeVTisalmostneverirregularStep4:LookatthePwavesPwavespresent?IsthereaPbeforeeveryQRS?Whatistherelationshipb/wthePandtheQRS?WhatisthePwaverate?Ventricularrate?IsthePwavecomingfromtheS
7、A?Naxis:uprightinII,negativeinaVRIsthere>1distinctPwavemorhology?DiagnosticTrick:50mm/sECGTracingsComparsionstudyof8EP’sGiven45ECG’sofNCT’sprintedat25mm/s&askedtogiveDx&Txplan2wkslatergivensameECG’sprintedat25&50mm/s&askedtogiveDx&TxResults50mm/sincreaseddiagnosticaccur
8、acyfrom63to71%,P=0.002JEmergMed2002;22:123–126FinalCategorizationNarrowComplexTachycardiasRegularw/P’s=sinus,a
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