What is a broad complex tachycardia?

ECG shows rate of > 100 BPM and QRS

complexes of > 120ms
What are the two principles of If in doubt, treat as VT
management of broad complex Identify the underlying rhythm and
tachycardia? treat accordingly
What is the DD for BCT? VT including TDP (if > 3 QRS
together at a rate > 100, its VT)
SVT with abberant conduction (e.g.
AF, AFl with BBB)
Pre-excited tachycardia (e.g. AF, AFl,
or AVRT with underlying WPW)
Does VT respond to adenosine? Nope
What are the ECG findings in favour of VT? Positive QRS concordance in the
chest leads
Marked LAD
AV dissociation or 2:1 or 3:1 AV
block
Fusion beats or capture beats
Brugadas criteria (e.g. RSR in V1
and positive QRS in V1)
What is the management of broad complex Monitor
tachycardia? Defrib attached
Oxygen
Correct electrolytes
Check for adverse signs (low GCS,
clammy, BP < 90)
ECG
IV access
What should you do if the patient is Sync cardiovert
haemodynamically unstable? Correct any hypokalaemia and
hypomagnesaemia
Amiodarone 300mg IV
What should you do if the patient is Correct K and Mg
haemodynamically stable? Amiodarone 300mg IV via central
line
What should you do after correction of the Establish cause
VT? Maintenance anti-arrhythmic
therapy
What is the management of TDP? Magnesium sulphate
Describe the BCT algorithm No pulse arrest
Pulse
o Oxygen
o IVI
o ECG
o No adverse signs
Correct electrolytes
 If regular give
amiodarone and
assume VT (if known
SVT or BBB, give
adenosine)
If irregular (AF with
BBB, Pre-excited AF,
TDP)
If no success, sedate
and sync cardiovert
o If adverse signs
Sedation
Up to 3 sync
cardiovertions
Amiodarone 300mg
Check electrolytes
If refractory consider
Lidocaine
Procainamide
Flecainide
Overdrive
pacing