Epidemiology - common in post-op! Risk factors = continuous EKG
Risk of prolonged QTc: Tisdale Risk Score for QT Prolongation
Pause dependent arrythmia - more likely in bradycardia
Defined as long QT polymorphic Vtach (QTc > 500ms)
Treatment:
Discontinue all QT prolonging meds
Fix Mg, Ca, K
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Magnesium (1-2g infusion, maintain levels over 5mg/dL for at least 24 hrs (likely caused by combo of medications, lets them wear off to prevent recurrence)
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High-Normal K (over 4mmol)
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If hemodynamically unstable (low BP or vfob conversion)
Electricity (unsynchronized defibrillate - cardioversion likely doesn’t work due to machine being unable to capture rhythm) -
Chronotropic support: epi or isoproterenol
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Refractory: IV lidocaine 1mg/kg (shortens all the intervals!)
DDx: (things that look like it on EKG)
Hyperkalemia (sine wave)
Afib w/ WPW