Wednesday, December 17, 2014

Q: Which of the following can be used as a treatment in Torsade de Pointes except

A)Overdrive intravenous pacing
B) Cardioversion
C) Phenytoin
D) Lidocaine
E) Isoproterenol
F) Amiodarone 

Answer: F

Best treatment of Torsades De Pointes is removal of an offending cause like hypokalemia, hypomagnesemia, drugs causing prolong QTc prolongation.

IV Magnesium is the drug of choice, as bolus of  1-2 g IV over 30-60 seconds, followed by a continuous infusion. Supplemental potassium may help. Phenytoin, Lidocaine, Mexiletine and Isoproterenol has been suggested.

QT interval shortens with a faster heart rate, so overdrive pacing can be effective  at a rate of 90-110 bpm until the QT interval is normalized. Overdrive pacing may be necessary at a rate of up to 140 bpm to control the rhythm.Conversion with combination of phenytoin and overdrive pacing as been described frequently.

Amiodarone which is the mainstay of treatment in ACLS usually is ineffective. Objective of the above question is to highlight the importance of the identification of the proper rhythm. Torsade is extremely common in ICU mostly due to either electrolyte disturbance of multiple offending drugs.

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