TACHYCARDIA
HR>150
Secure Airway
O2 if needed
Attach O2 sat pulse cardiac monitor BP and
Look at pt
STABLE TACHY = DRUGS
UNSTABLE TACHY- Synchronised Cardioversion
V Tach Arrest Drugs/Shock /Drugs/Shock
DX
STABLE/ TACHY/ NARROW COMPLEX /REGULAR
RX DRUGS
Could be symptomatic but hemodynamically stable
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
Also try vagal manouver
If adenosine does not work use B blocker calcium channel blocker
Eg Verapamil 5mg over 5 minutes
STABLE/ TACHY/ NARROW COMPLEX /IRREGULAR
RX DRUGS
Verapamil Slow IV push 5mg over 5 minutes
Cardizam Diltiazam Drip 5-15mg/hr
or Cardizam (Diltiazem) .25mg per kg over 2-5 minutes
UNSTABLE /TACHY /NARROW COMPLEX /REGULAR OR IRREGULAR
RX SHOCK
Narrow regular 50-100J
Narrow Irregular 120-200 J biphasic
Or 200 J biphasic
Wide Regular 100J
Wide irregular defib dose (not synchronized)
STABLE/ TACHY/ WIDE COMPLEX /REGULAR
| Patient | Treatment |
| The patient’s QRS is narrow and rhythm is regular. | Try vagal maneuvers.
Give adenosine 6 mg rapid IV push. If patient does not convert, give adenosine 12 mg rapid IV push. May repeat 12 mg dose of adenosine once. |
| Situation | Assessment and Actions |
| Patient has significant signs or symptoms of tachycardia AND they are being caused by the arrhythmia. | The tachycardia is unstable. Immediate cardioversion is indicated. |
| Patient has a pulseless ventricular tachycardia. | Follow the Pulseless Arrest Algorithm. Deliver unsynchronized high-energy shocks. |
| Patient has polymorphic ventricular tachycardia AND the patient is unstable. | Treat the rhythm as ventricular fibrillation. Deliver unsynchronized high-energy shocks. |
NARROW COMPLEX IRREGULAR
Wide Complex (MD video)
WIDE COMPLEX QRS >.12 = >3 small boxes
Unstable
REMEMBER any instability shock hypotension synchronized cardioversion
Stable
Monomorphic or Polymorphic
Monomorphic Wide Complex
Ventricular tachycardia
Amiodorone 150 mg over 10 minutes iv infusion to max dose of 2.2g /24 hrs
If VT occurs Repeat
Ventricular Fibrillation
Epi 1mg (1/10,000)/ every 3-5min NO MAX
Vasopressin (1 dose of ) 40U iv/io to replace 1st or 2nd dose of epi
Amiodorone 300 mg over 10 minutes iv infusion to max dose of 2.2g /24 hrs
Lidocaine
Ventricular Fibrillation Arrest Drug Shock Drug Shock
When in doubt treat for V Tach No harm in Rx with Adenosine – If it does not work probably not atrial in origin
Wide Complex Regular (monomorphic )
Stable Wide Complex
Procainamide
20-50mg/min until
arrhythmia is suppressed
hypotension
QRS> 50%
Max dose 17mg/kg