ACLS Tachycardia Narrow Complex Regular

Narrow Complex Regular Tachycardia

 

Usu

100 = tachycardia Cause be dehydration, fever, anxious reaction to drugs

>150 Could it be cardiac in origin?

Width of QRS should be less than .12

 

Supraventricular Tachycardia

3 Situations

  1. StableCould be symptomatic (dizziness, palitations) but hemodynamically stable = BP>90, mentating good color MEDICATION
  2. Unstable Signs of shock, altered mental status, color/cyanosis SYNCHRONISED CARDIOVESRION
  3. PEA EPINEPHRINE

If narrow complex REGULAR consider

Assessment  Stable with a Pulse/BP

  1. Conciousness OK
  2. Breathing  OK oxygen
  3. Pulse Rapid Thready O2 , Monitor,IV
  4. BP OK >90
  5. Supraventricular Tachycardia

    DX Narrow Complex Regular Stable Tachycardia

Rx MEDICATION

1- Adenosine 6mg rapid  IV push

follow with 20ccs saline half life very short few seconds)

After 2 minutes 2nd dose 12mg iv push follow with saline

2- Also try vagal manouver, Valsalva

3 If adenosine does not work use B blocker calcium channel blocker

Eg Verapamil 5mg over 5 minutes

 

2nd Scenario

  1. Conciousness Not OK  Unstable – Call CODE
  2. Breathing  Not OK O2 bagging
  3. Pulse Not OK Rapid Thready Monitor,IV
  4. BP <90
Supraventricular Tachycardia
DX  UNSTABLE Narrow Complex Tachy Cardia

RX Synchronised Cardioversion

press HOLD DOWN SYNCH BUTTON Until it has sensed the Rhythm 

50J

 

3rd  Scenario

  1. Conciousness Not OK Call Code
  2. Breathing  Not OK )2 and Airway
  3. Pulse ABSENT Monitor,IV
  4. BP absent
Normal Sinus Rhythm

DX  Unstable No Pulse = PEA

RX Epinephrine Vasopressin

 

Epi 1mg (1/10,000)/3-5min

PEA EMD (need pressure 40-60 systolic to feel an pulse)

Rhythms that cannot be PEA Vfib V tach and asystole

Epi 1mg every 3-5mins

Chest Compressions

Vascular Access (Interosseous infusion)

Consider Advanced Airway

ET CO2 monitoring

 

OTHER DRUGS

1 dose of Vasopressin 40 U iv/io to replace 1st or 2nd dose of epi

Asystole or slow PEA rate atropine 1mg iv every 3-5mins (up to 3 doses)

FOCUS ON WHAT IS THE CAUSE

2 leading causes

H and T Hypovolemia and hypoxia

Narrow Complex Tachycardia = volume depletion

Wide Complex slow – = dying heart

H and T’s

Hypoxia

Hypovolemia

Hydrogen (acidosis)

Hypo hyperkalemia)

Hypothermia

Toxins

Tamponade

Tension Pneumothorax

Thrombosis(coronary and PE)

Trauma