2 Establish and TreatPossible Causes

Adenosine 6 mg rapid IV push, follow with NS flush

2nd Dose: 12 mg

Adult Tachycardia (with Pulse)

Secure patient airway, assist with respirations as neededAdminister oxygen if hypoxicAttach cardiac monitor, monitor BP and SPO2

1 Identify SVT(Heart rate >150)

Synchronized CardioversionStarting Doses:

Antiarrhythmic Infusions(Stable Wide-Complex)

Amiodarone: 150 mg over 10 min Repeat as necessary if VT recurs

Procainamide: 20-50 mg/min until arrhythmia is suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose of 17 mg/kg is reached

Sotalol: 100 mg (1.5 mg/kg) over 5 min

3 Hypotension?Shock?

Ischemic Chest Pain?AMS?

Heart Failure?

4 QRS Wide?(> 0.12 sec)

No

5 Immediate SynchronizedCardioversion

Yes

If regular narrow complex, consider Adenosine

_

6 Establish vascular accessRun 12-Lead ECG if possibleConsider adenosine only if monomorphic and regularConsider antiarrhythmic infusionSeek expert consult

7 Establish vascular accessRun 12-Lead ECG if possibleConsider vagal maneuversAdenosine (if regular rhythm)Administer -Blocker or Calcium Channel BlockerSeek expert consult

No

Yes

Narrow regular: 50-100 JNarrow irregular: 120-200 J biphasic or 200 J monophasicWide regular: 100 JWide irregular: defibrillation dose (Not synchronized)