The Internet Book of Critical Care Podcast IBCC Episode 12 - Torsades De Pointes
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Nov 21, 2018 Learn about the diagnosis and treatment options for Torsades de Pointes, including the use of cardioversion, magnesium, and allitacane. Discover how to prevent recurrence with high doses of magnesium and monitoring electrolyte levels. Explore the use of lidocaine and chronotropy in treatment.
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Immediate Treatment for TdP
- Treat unstable polymorphic VT or Torsades de Pointes (TdP) with immediate defibrillation.
- Prepare for cardioversion even if the patient is initially stable, as their condition can deteriorate rapidly.
TdP: A Transient State
- Torsades de Pointes is typically a transitional state, not a sustained rhythm.
- Patients in TdP will likely either revert to normal sinus rhythm or deteriorate into ventricular fibrillation.
Preventing TdP Recurrence
- Prevent TdP recurrence with high-dose magnesium sulfate, targeting serum levels between 3-5 mg/dL (1-1.8 mmol/L).
- Maintain magnesium infusions for approximately 24 hours, along with potassium levels above 4 mEq/L.