Wide Complex Tachycardia

Wide complex tachycardia requires a systematic approach in the emergency department, prioritizing electrical cardioversion for unstable patients while utilizing diagnostic algorithms for stable cases. Ventricular tachycardia remains the default diagnosis until proven otherwise, as it accounts for the vast majority of these presentations. Key diagnostic strategies include evaluating for concordance on 12-lead ECGs and reviewing prior tracings to distinguish between ventricular tachycardia and supraventricular tachycardia with aberrancy. While adenosine can help differentiate rhythms in stable patients, clinicians must remain prepared for potential hemodynamic deterioration. Management involves identifying underlying causes like electrolyte derangements or toxic ingestions, such as digoxin or sodium channel blockers, and employing targeted interventions like calcium or sodium bicarbonate. Ultimately, maintaining a low threshold for early cardiology consultation and aggressive electrical intervention ensures optimal patient outcomes during these high-risk resuscitations.