adult tachycardia (with pulse) adult tachycardia (with pulse) secure patient airway, assist with...

2 Establish and Treat Possible 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 needed Administer oxygen if hypoxic Attach cardiac monitor, monitor BP and SPO2

1 Identify SVT (Heart rate >150)

Synchronized Cardioversion Starting 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 Synchronized Cardioversion

Yes

If regular narrow complex, consider Adenosine

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6 Establish vascular access Run 12-Lead ECG if possible Consider adenosine only if monomorphic and regular Consider antiarrhythmic infusion Seek expert consult

7 Establish vascular access Run 12-Lead ECG if possible Consider vagal maneuvers Adenosine (if regular rhythm) Administer -Blocker or Calcium Channel Blocker Seek expert consult

No

Yes

Narrow regular: 50-100 J Narrow irregular: 120-200 J biphasic or 200 J monophasic Wide regular: 100 J Wide irregular: defibrillation dose (Not synchronized)