21 Nov 2018
15m

IBCC Episode 12 - Torsades De Pointes

Podcast cover

The Internet Book of Critical Care Podcast

This podcast episode focuses on the diagnosis and treatment of Torsades de Pointes (TdP). The discussion clarifies the distinction between Torsade, which involves a prolonged QT interval, and non-Torsade polymorphic VT, which requires a different treatment approach. The speakers emphasize immediate defibrillation for unstable patients and recommend high doses of magnesium to prevent recurrence, targeting levels between 3 and 5 mg/dL, while also maintaining healthy potassium levels above 4. They caution against using amiodarone, which can worsen QT prolongation, and advocate for a systematic magnesium infusion protocol to ensure consistent treatment. Additional therapies mentioned include lidocaine and chronotropy via electrical pacing or infusions like isoproterenol or epinephrine.

Outlines

Part 1: Diagnosis, Contraindications

Part 2: Acute Management, Magnesium Therapy

Part 3: Refractory Cases, Alternative Therapies

Part 4: Summary, Clinical Pitfalls

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