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)