ECMO - האיגוד הישראלי לרפואה דחופה

ECMO - האיגוד הישראלי לרפואה דחופה

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ECMO - האיגוד הישראלי לרפואה דחופה episodes

  • PODCAST: Electrical Storm
    Show Notes

    Background/Overview of VT:

    • Definition: What makes it a storm
      • Three or more sustained episodes of VF, VT, or appropriate ICD shocks in a 24-hour period
      • Pathophysiology: Understanding the origin and mechanism
        • Sympathetic drive/adrenergic surge
        • Underlying pathology: Sodium channelopathies, infiltrative disease like cardiac sarcoidosis, etc.
        • RF’s / trigger / population (reversible cause in ~25% of patients)
          • MI
          • Electrolyte Derangements (emphasis on potassium and magnesium)
          • New/worsening heart failure
          • Catecholamine Surge
          • Drugs (stimulants, cocaine, amphetamines, etc)
          • QT Prolongation
          • Thyrotoxicosis

            • Clinical Presentation:

            • Symptoms of VT: spectrum of symptoms – from palpitations to syncope to cardiac arrest
            • Differentiating VT from other potential ER presentations.

              • Diagnostics in ER:

              • Electrocardiogram (ECG): Recognizing VT patterns.
                • Monomorphic vs polymorphic (Torsades) may change management
                • Wide QRS
                • Fusion best
                • Capture beats
                • Concordance
                • AV-dissociation
                • Lab tests: Potassium, magnesium, troponins, TFTs, etc.

                  • Acute Management in the ER:

                  • Hemodynamically stable vs. unstable V
                    • Unstable = cardioversion
                    • Sedation
                      • Catecholamine surge should be considered
                      • No ideal agent
                      • Etomidate or propofol can be considered
                      • Ketamine may worsen irritability
                      • Pharmacological treatments:
                        • Amiodarone
                          • Class III antiarrhythmic
                          • Most studied in VT storm
                          • First line
                          • Beta Blockers
                            • Propranolol
                            • B1 and B2 activity
                            • Non-pharmacological approaches:
                              • Immediate synchronized cardioversion
                              • IABP / ECMO considered for HD unstable patient
                              • Cath lab if ischemic etiology suspected
                              • Stellate Ganglion Block

                                • Take Home Points

                                • Definition: VT Storm is commonly defined as three or more sustained episodes of ventricular fibrillation, ventricular tachycardia, or appropriate ICD shocks within a 24-hour period.
                                • Varied Presentation: Patients may experience a range of symptoms from palpitations to severe hemodynamic instability.
                                • ECG and Diagnosis: Initial ECG may not show VT; continuous cardiac monitoring or device interrogation may be required for diagnosis.
                                • VT Identification: Look for wide QRS, rate over 100, fusion beats, capture beats, and AV dissociation to identify VT.
                                • Management in Hemodynamic Instability: Cardiovert if the patient shows signs of hemodynamic instability.
                                • Sedation Considerations: Be cautious with sedation, especially with ketamine, as it may worsen cardiac irritability in these already adrenergic state patients.
                                • Medication Choices: Typically, amiodarone and propranolol are used to manage VT Storm.
                                • Cardiology Involvement: Involve cardiology early on, as treatment may extend beyond medications.

                                  • The post PODCAST: Electrical Storm first appeared on האיגוד הישראלי לרפואה דחופה.

                                  11 min

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