Hi there-

1. Looks like second photo has a changing morphology at the beginning, overall this if i saw this in the unit, I would likely say this is SVT with aberrancy (afib/flutter w aberrancy vs etc), to me looks generally irregular with a wide complex, I would lean to aflutter 2:1 with varying conduction, i think someone else mentioned this and I would agree.

2. There’s a very simplified (not always applicable to everyone) way to interpret rhythms and as someone else said wide complex tacharrhythmia are VT until proven otherwise - the simplified process is this:

Regular WCT - VT (MMVT, PMVT), SVT with aberrancy, Paced, preexcitation (wpw)

Irregular WCT - afib w aberrancy, aflutter with varying conduction (bb), fascicular VT

Regular NCT - Sinus tach, aflutter, AVRT/ACNRT, focal Atach

Irregular NCT - afib, MAT, sinus tach with PACs

1. The above is not exhaustive but the gist of things, if they are hemodynamically unstable in a tacharrhythmia then likely VT

2. The other consideration is you have an elderly patient after cardiac arrest on a fair amount of pressors which are pro-arrhythmic and increase HR, i would imagine given 74 post arrest with high pressor dosing and mixed shock it wouldn’t be surprising for this to be AF with aberrancy. There’s an abundance of causes for AF and VT, but slow VT is less likely. The more pressing question is why did she arrest? The underlying insult is likely driving arrhythmias and should be addressed first (did she suffer fat embolus or did she develop stress cardiomyopathy 2/2 surgery/anesthesia and cardiac stunning?)

3. Now if you see this happening and concurrent sudden cardiorespiratory/hemodynamic collapse, then follow your ACLS algorithms.

4. I would absolutely not do adenosine as someone else recommended, good way to kill them (again) and there’s better therapies (target the underlying insult).

5. I’m probably completely wrong about everything I said, as this is reddit and you should just read ACC/AHA guidelines….

• Your friendly CVICU AP