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Cardiology
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Wide-Complex Tachycardia
Flowchart
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AV dissociation/fusion = VT. Then ask stable vs unstable.
Decision
Outcome
Decision
Wide-complex tachycardia. Decisive features?
✓
AV dissociation, fusion or capture beats → ventricular tachycardia
✗
Narrow QRS only
Decision
Hemodynamic status?
✓
Stable → IV amiodarone (alt: procainamide, lidocaine)
✓
Unstable (hypotension, AMS, distress, ischemia, AHF) → synchronized cardioversion
✓
Pulseless → defibrillate + ACLS
Outcome
IV amiodarone 150 mg over 10 min, then infusion
Outcome
Synchronized cardioversion 100 J biphasic, escalate as needed
Sedate if conscious (etomidate, midazolam).
Outcome
Unsynchronized defibrillation; full ACLS