Wide Complex EKG

jcroteau said:
Hey everyone, new medic student here.....I'm having trouble posting my own topic in this forum.....so I thought this may be the most appropriate thread to ask my question.

Can someone please tell me why wide qrs complexes are bad? Does it have something to do with r on t?

I've asked numerous medics and the only answer I keep getting is "it just is"
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Hello. Many rhythm questions (as you are a medic student), aren't always a straight forward answer .... Unfortunately.
I work in a Cath Lab and cross trained for EP Lab. If you would like help with rhythms and 12 Leads and general cardiology, I'd be happy to help. However answers may be more suitable for private threads or email.
 
jcroteau said:
Hey everyone, new medic student here.....I'm having trouble posting my own topic in this forum.....so I thought this may be the most appropriate thread to ask my question.

Can someone please tell me why wide qrs complexes are bad? Does it have something to do with r on t?

I've asked numerous medics and the only answer I keep getting is "it just is"
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R on T is a separate issue from Wide Complex QRS. R on T can happen with many rhythms, but more involved with QT intervals and premature beats.
And as for "it just is" - is not the answer medics should give to those learning. We should be striving for better care ... and helping each other. Wide QRS is the norm for some people. So for those ... its not that bad. Wide QRS can be a morphology change, like changes in rhythm that aren't necessarily life threatening .. kinda like A-Fib. A-Fib is not good, but people live with it. On the other hand, Wide QRS can also be bad. Acute changes resulting in potential lethal rhythm changes. Electrophysiology can be very complex. Looking at the morphology of the heartbeat, the P-wave, the QRS complex, and the T-wave, can tell you a lot about the heart.
 
I guess my question would turn into why do we treat it with sodium bicarb....what would happen if we just left it as is? The potential to deteriorate into more lethal rhythms?
 
jcroteau said:
I guess my question would turn into why do we treat it with sodium bicarb....what would happen if we just left it as is? The potential to deteriorate into more lethal rhythms?
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Treat what with sodium?
 
jcroteau said:
Wide complex QRS......anything over 0.12 seconds we're giving bicarb.
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I'd love to hear the reasoning behind this.

I 100% agree with basically everything you said until this post.
 
Sorry sorry sorry. I totally could have worded that better......any of the following with a wide QRS we are giving bicarb;

CCB or BB Overdose, Sympathomimetic OD or TCA OD

So I guess I'm asking if we have a wide QRS complex secondary to any of the above why are we treating it and what could happen if we didn't.
 
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Bicarb is used in TCA overdose, but can't say I've heard of it being used in the others.

Bicarb is fairly standard in cardiac arrest, including pulseless Vtach, but that's to treat acidosis.

Not sure what or where exactly your information is coming from. Seems a little off.
 
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jcroteau said:
Sorry sorry sorry. I totally could have worded that better......any of the following with a wide QRS we are giving bicarb;

CCB or BB Overdose, Sympathomimetic OD or TCA OD

So I guess I'm asking if we have a wide QRS complex secondary to any of the above why are we treating it and what could happen if we didn't.
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As far as I know bicarb is not indicated in CCB or BB OD. In the acute phase at least.

TCA OD absolutely, the question is do you know why outside of "the protocol says so"?
 
I stand corrected.

http://emcrit.org/wp-content/uploads/ccb.pdf

With that said I'm not super keen on messing with people's blood chemistry unless I absolutely have to. We don't give bicarb for CCB or BB ODs, only TCAs on standing orders of 1mEq/kg once.

Gone untreated it will result in a cardiac arrest but like I said unless they're severely symptomatic, read: peri-arrest or prolonged seizure activity refractory to benzodiazepines, I'm not going to **** with someone's pH.
 
I've been doing this for a while, and it's been years since I've seen a pacemaker have problems, so I'm not inclined to think that this is her pacer (nor do I see any pacing spikes or indicators from the monitor that it is detecting a pacemaker). I don't think it's an aberrant conduction either, because usually that occurs at a higher rate.

I'm sticking with v-tach on this one. While I'm not a huge fan of Amiodarone, I would probably hang it in this case because those are some pretty sustained runs of v-tach.
 
With the Zolls I have to drop the age to like 3 years old to get the pacer spikes to show up on the 12 lead. Sounds like a dual chamber pacer. No need for intervention. Remember if your not sure if it's a paced tach or ventricular tach you can always wave a pace magnet and drop the hr back to programmed rate.
 
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