Sinus tachycardia differential


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Edward M. Omron MD, MPH, FCCP
Pulmonary, Critical Care and Internal Medicine
Morgan Hill, CA 95037

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Sinus tachycardia differential

  1. 1. Sinus Tachycardia Differential 1. HR 100-160, PR 0.12-.20, QRS <0.12 2. Differential a. Pain (Assess pupillary diameter, pinpoint with adequate narcotics) b. Fever (T>101.5, Acetaminophen/ Ibuprofen/ Fans with cool mist) c. Anxiety (Clinical Assessment) d. Thyrotoxicosis (T4 and TSH, T3 level) e. Pulmonary Embolism (Spiral CT, ECHO) f. Shock i. Hypovolemia (Volume Challenge) ii. Sepsis ( Clinical Assessment) iii. Cardiogenic (Clinical Assessment) iv. Neurogenic (Clinical Assessment) v. Distributive (Clinical Assessment) vi. Massive Pulmonary Embolism (Spiral CT, ECHO) g. Cardiac Ischemia or CHF (Ischemia Protocol, BNP) h. Withdrawal (Alcohol, illicit drugs, Caffiene, Tobacco) (History) i. Pneumothorax (CXR) j. Drugs (B agonists, Dopamine, Epinephrine, Norepi, TCA’s, Antihistamines, SSRI, Haldol…) (Drug Review) k. Cardiac Tamponade (ECHO) l. Hypoxia (ABG, VBG) m. Hypercarbia (ABG, VBG) n. Metabolic Acidosis (ABG, lactate, and chemistry panel) o. Hemorrhage/ Anemia (ABG, VBG, lactate, CBC) p. Cirrhosis (RUQ US) q. Pheochromocytoma (Urine Metanephrines) r. Shunt Fraction (ARDS, Patent Foramen Ovale, AV fistula) (1- SaO2)/(1-SvO2): Normal ≤ 10% (Need Central Venous Access) 3. Approach to management a. 12 Lead ECG b. Review above causes and rule out individually. Edward M. Omron MD, MPH, FCCP Pulmonary / Critical Care Service