Wide Complex Tachycardia: Get Comfortable With Uncertainty

Learn a systematic approach to management of wide complex tachycardia that doesn't rely on exact rhythm identification or scoring systems with guest Dr. Kevin Butler. By understanding the physiology rather than memorizing a score or algorithm you can use Kevin's approach and ABCD mnemonic to help differentiate between ventricular tachycardia, SVT with aberrancy, and other arrhythmias. Learn how not to miss the vital mimics with his SPAM filter. And finally by understanding which treatments are safe and which treatments potentially dangerous you can understand how to move forward even when you're not exactly sure what the arrhythmia is. Whether you're an EMT, paramedic, or emergency physician, this episode provides the essential principles and stepwise strategies to ensure effective and safe patient management.

00:00 Introduction to Arrhythmia Management

00:29 Personal Anecdote: Lessons from Paramedic School

02:04 Introducing Dr. Kevin Butler

02:16 Sponsor Message: The Recess Tailor

03:35 Welcome to EMS Cast

04:04 Understanding Wide Complex Tachycardia

05:37 Approach to Arrhythmia Management

07:02 Principles of Managing Wide Complex Tachycardia

08:39 Pathophysiology of Wide Complex Tachycardia

18:30 Identifying and Treating Mimics

26:55 Regular vs. Irregular Wide Complex Tachycardia

29:59 Understanding Torsades and Its Management

30:25 Identifying Atrial Fibrillation with Pre-Excitation

32:14 Treatment Considerations for AFib with WPW

35:02 Distinguishing Between VT and SVT with Aberrancy

37:09 Physiological Approach to ECG Interpretation

40:24 ABCD Mnemonic for VT Diagnosis

47:49 EMS Treatment Protocols for Wide Complex Tachycardia

51:54 Pre-Hospital Cardioversion Tips

55:22 Emergency Department Approach to Wide Complex Tachycardia

58:00 Final Thoughts and Key Takeaways

Resources

• The Resus Tailor
• Episode Blog Post with EKG examples
• Survey- Help us learn what content you want

Gear We Like

• Good Stethoscope - https://amzn.to/3YJJrf2
• Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn 
• Notepad for taking notes on calls - https://amzn.to/3Z1X21J
• Sunglasses - https://frontline-optics.com/discount/EMSCAST15
• Books we recommend - 
  • The Dichotomy of Leadership - https://amzn.to/4fiCAjN
  • Extreme Ownership - https://amzn.to/3O1FWfa
  •  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf
  • Thinking Fast and Slow - https://amzn.to/4fiJG85
  • A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2

Guest/Cast/Crew information-
Guest- Dr. Kevin Butler, Emergency Physician, Lead Instructor for DHREM's EKG didactic curriculum
Host- Ross Orpet, Will Berry 

Catch up with us after the show

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• Website- www.emspodcast.com