Hello, I'm an expert in emergency medicine with a focus on cardiac care. When it comes to treating Torsades de Pointes, a specific type of ventricular tachycardia, the approach can be nuanced.

Do you defibrillate torsades?

No, you typically do not defibrillate for Torsades de Pointes. Torsades de Pointes is a polymorphic ventricular tachycardia associated with a prolonged QT interval, often due to medications or electrolyte imbalances. The initial treatment for Torsades de Pointes is not defibrillation but rather cardioversion, which is a synchronized electrical shock to the heart. This is because Torsades de Pointes is a self-terminating rhythm that often corrects itself, but can be life-threatening if it leads to a more sustained form of ventricular tachycardia or ventricular fibrillation.

The immediate management includes:

1. Ensuring the patient has a patent airway and is breathing adequately.
2. Checking for and treating any reversible causes, such as electrolyte imbalances (particularly magnesium and potassium).
3. Administering magnesium sulfate, which is often the first-line treatment for Torsades de Pointes.
4. If the patient is hemodynamically unstable or the episodes are recurrent, synchronized cardioversion may be necessary.

Defibrillation, which is a non-synchronized shock, is used for treating ventricular fibrillation or pulseless ventricular tachycardia, not for Torsades de Pointes.

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One commonly seen type of polymorphic ventricular tachycardia is torsades de pointes. ... Unstable polymorphic ventricular tachycardia is treated with unsynchronized shocks (defibrillation). Defibrillation is used because synchronization is not possible.read more >>