Wide Complex Tachycardia: is the patient stable or unstable?

Here is another case written by Pendell Meyers, a G2 at Stony Brook. As I mentioned before, Pendell will be helping to edit and write the blogSpecial thanks to Dr. Atif Farooqi who cracked this case for me.CaseA male in his 50s with history of " SVT with two prior failed ablations " presented for acute onset palpitations and shortness of breath. He appeared mildly short of breath and diaphoretic, but he was mentating perfectly, laughing about how many times he had been in this same situation. His initial automatic BP was 83/51, immediate manual pressure was 98/58.Before we even get to his ECG, is he " stable " or " unstable " ? This of course depends on your definitions, prior experience, and various other factors. If you care how the ACLS guidelines defines " stable vs. unstable " , then prepare yourself for confusing and contradicting descriptions. ACLS defines unstable as " a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent. " (1)Problem #1: Acute vital organ impairment is a definitively different level of instability compared to imminent or ongoing cardiac arrest. An asthma attack may constitute acute impairment of a vital organ ' s function, but clearly does not imply impending cardiac arrest.They then give a list of suggested criteria which satisfy that condition, including terms such as " ischemic chest discomfort " and " acute heart failure. " (1)Problem #2: These terms have high interobserve...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs