How do you avoid a clean kill with wide complex tachycardias? 

I dream of being a resident under Mattu's supervision.

This should be seen by every paramedic

I saved a patient because of you. Thanks

This has to get more attention. The fact that hyperK could mimic ventricular rhythms was covered in paramedic school, but the importance of avoiding sodium channel blockade was not. I've been in EMS for 7 years, and it wasn't until an MCHD episode I heard recently that I was aware of just how serious this differential is. This should be beat into our heads just like continuous compressions or early defibrillation.

Every single word of this genius is pure gold

I have attempted Synchronize Cardioversion on this kind of pt before as a first year Paramedic. They didn't really touch on this in school. Great video.

As a young resident once I put a temporary pacemaker in a patient with hyperkaliemia who had a slow rhythm and wide QRS BEFORE drawing blood for potassium and ABG...Luckily for him and me, it turned down just fine, after administering some bicarbonate and calcium iv

Getting myself back into paramedicine. Very, very good refresher. Thank you.

Thank you for what you do. I always learn something from your presentations, and they are always entertaining as well!

I do love you Mr Mattu. I love listening to you...you make ECG increasingly easy for me.

This is absolutely brilliant, entertaining , exciting . What a Joy. I don’t have any other words.

Nice talk, this guys teaches others how to be better at saving lives 👏👏👏

i love this speaker 😂❤ my favorite teacher in this series.

Another awesome period of instruction. Thank you!

Really enjoyed this lecture. Very helpful for those rhythms that may not have us sold that they are actually V-Tach!

Thank you Doc.

Thank you so much for this video! It was really enlightening!

Lecture of outstanding quality 👌

Thank you very much brilliant doctor

You are a great teacher..!! Thanks a lot

Great teaching and superb teacher

Superb talk

Such a great piece of information. Never heard before.

This video is excellent.

Fantastic video .. Thank you so much..

Thank you again and again

You are saving lives sir

Thank you very much, very useful lesson

I really like the concept of a treatment with the worst scenario outcome being patient's bones get stronger.

Brilliant. Magic. Thank you.

Wow! Fantastic. Never knew this. Just added some valuable Pearls to my medical collection......

Great information

You are awesome, May God reward you for that

superb teacher

Thanks!

Thanks, Amal!!

Nice work........

Thank you!

Thank you sir.

Amazing!

Great talk. But I'd like to point out that ACLS DOES consider E'lytes etc in their algorithm.... it's actually the first step after ABCD to look out for "reversible causes" Amio comes much further down. So ...ACLS - if done properly - won't kill your hyperK or acid patients. Still, great talk.

Great teaching

Thank you for this sage advice. Primum no-kill-em!

I always chose propofol and 200 joules over cardizem or amiodarone. I mean for myself, presenting with atrial fib.

excellent

great info.

Had the same case today thanks to this video,I picked it up ,gave gluconate instead. Potassium was 8.

That was awesome

I am glad some one so good in cardiology thinks and interprets ekg's like me. :D

Wonderful 🎉

Fantastic 👌🏻👏🏻

I am a retired RN ( 40 year career) and at one time did critical care and taught ACLS. I just now came across your video regarding toxic and metabolic causes of wide complex tachycardia and found the information to be fascinating and informative. Thank you.

Mortality rate is very high in ours emergency department.

Amazing... Genius indian

This is a physician I would love to do a residency with.

This dude's too OP

Great lecture. I will note that the sick patients that might end up with such wide complex tachycardias (whether hyperK or VT) aren’t the normal people in the room... so not sure if calcium is 100% innocuous

So in pinned pts when we see HyperK buildup and we can't get access, we give albuterol to counter the HyperK status for a bit. Can you use that same trauma algorithm for RRWCT pts just to hold them over while you get access and drugs set up? I'm curious if it's a deviation of protocol or would it be considered using the wrong protocol for the right reason? Strictly speaking, on a living pt of course

excellent new knowledge for me. thanks to god i didn't commit clean kill before ^_^

I sea the Video on 2023 thanks a lot for this information I didn’t hear the dose of ca or bicarbonate can any one mention it please

i wanna be a student of amal mattu

Won’t bicarbonate’s 2 ampules will lead the pt towards brain edema?

You r right

This isnt Ventricular Tachycardia, this is bordering on *“sine wave pattern”* which is a very well recognised EKG manifestation of hyperkalaemia.

OMG! You're scaring me. ERs seem to be very dangerous places for any patient.

Don't they do blood gases in US?

But why is that pt so tachy in that case?

Alma Matthu is HILARIOUS with these comments "What happens when you give calcium to somebody who's not actually hyperK?" 5:36 leading up to punchline 5:41 LOL "Who programs EKG machines?" 7:24 LOOOL

Is there not easy access to venous blood gases in American Emergency Medicine? Sodium bicarbonate is not harmless if the reason for their VT is hypokalaemia.

07:19 🏆💖

What did he say? "Who programs the ecg machine? ... " I didn't understand it

Another good landmark could be: wide QRS kompl and a patient talking to you, with normal bp makes v tach unlikely.

What kind of calcium? Calcium chloride?

Not sure if you still look at the questions on here. If you cardioverted this gentleman would he have responded to that, given that it was hyperK?

why do we follow acls vfib algorithm which includes amiodarone in a patient that has known renal failure, hyperkalemia that eventually turned into a Sine wave then vfib? I'm asking because if the sodium channels are inactivated by hyperkalemia why give a sodium channel blocker? The more I read about hyperkemic cardiac arrest (meaning patient demise on arrival to the ER, EKG gets worse. k is elevated) I wonder why it 100% contraindicated in hyperkalemic RRWCT but the literature says follow acls protocol if you have a pt in vfib? I am reading that cpr should be prolonged so there's time to correct the k level. even hook them up to hemodialysis to try to get rosc back....so why do we stop after 30 min?

Calcium chloride or calcium gluconate?

Watching in 2022

This is scary that doctors aren’t getting taught this in school and have to go to a convention (or RU-vid) for this LIFE SAVING information. Guess that’s why it’s called, practice 🤷🏽‍♀️

two amps you mean two ampoules ??

People watch out for amiodarone as it is fatal; my husband took it at 200mg and died as he developed pulmonary fibrosis-irreversible damage to the lungs. Get a second opinion when possible. My family and I are so devastated by such tragic event-losing a loved one because of deadly medications, it's so sad when they're supposed to help heal, not kill.

Clean kill?

No harm in giving hco3, apart from getting severe hypokalaemia!!!! Get a vbg first...

HMM NOT VERY CONVINCED

Hey... show the EKG. I saw it for like 1 second. RU-vid people do not get to see the EKG. This video ends up being completely useless and without all this circumlocution, the video could be 3 minutes long and stop wasting people's time.

Why don’t change ACLS? Nice of you to talk about killing patients so haphazardly, really enforces my confidence in the medical profession. These are lives we are talking about. Not just statistics.