amirhossein wrote:
Stable pt: Lidocaine
Unstable pt: Cardioversion (defibrliation), synchronized cardioversion is not indicated.
Better answer than mine.
One more thing I want to mention. Because the title of this thread is TORSADES de POINTES, which is different kind of ventricular tachyarrhythmias from ventricular tachycardia, the treatment is different. IV magnesium is the first line for stable Torsades de Pointes patients, cardioversion for unstable patients.
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| Aashi
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Let me try ruling out one by one.
Stable pt--->no DC cardioversion--->torsades are usually self treminating-->or with Mg, and removal of drugs that prolongs QT interval...DC cardioversion is the LAST resort and torsades usually recurs after that, coz torsades is paroxysmal--->so CARDIOVERSION, ruled out
next is procaimides-->its the DOC for WPW--->and NOT for torsades-->hence ruled out
Amiodarone is the DOC for suatained MONOMORPHIC VT and VF and NOT torsades--->hence ruled out
Lidocaine---->Lidocaine usually has no effect in torsades and may be beneficial in the intial t/t for torsades, BUT torsades usually recurs and hence ruled out
The only one left is Phenytoin--->and is one of the drugs used in the managment of torsades, REFRACTORY to Mg( which is the DOC for torsades)and it inhibits the recurrences as well--->So I go for D
GL
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| amirhossein
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From www.emedicine.com:
* Institute immediate advanced cardiac life support (ACLS) protocol for VT.
* Overdrive pacing may be necessary at a rate of up to 140 bpm to control the rhythm.
* Treat hypokalemia if it is the precipitating factor and administer magnesium sulfate in a dose of 2-4 g intravenously (IV) initially.
o Magnesium is usually very effective, even in the patient with a normal magnesium level.
o If this fails, repeat the initial dose, but because of the danger of hypermagnesemia (depression of neuromuscular function) the patient requires close monitoring.
o Other therapies include overdrive pacing and isoproterenol infusion. Most (75-82%) torsade de pointes (TDP) rhythms are started by a pause. Pacing at rates up to 140 bpm may prevent the ventricular pauses that allow TDP to originate.
o The patient with torsade who is in extremis should be treated with electrical cardioversion or defibrillation. Anecdotal reports cite successful conversion with phenytoin (Dilantin) and lidocaine.
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All human wisdom is summed up in two words: wait and hope
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