Agorithm in giving emergency care to TACHYCARDIA

21/08/2009 18:13

TACHYCARDIA????     What to do????

1.       Assess and support ABC (Airway, Breathing, Circulation) as needed

2.      Give oxygen

3.      Monitor ECG (Identify rythm), Blood pressure, oximetry

4.      Identify and treat reverse causes

 

A.      UNSTABLE Tachycardia

(Signs: altered mental status, ongoing chest pain, hypotension, or other signs of shock)

a.      Perform immediate synchronized cardioversion

                                                              i.      Remember:    

A.      Sedate patient if conscious (do not delay cardioversion)

B.      Consider expert consultation

C.      If Pulseless arrest develop (Follow Pulseless arrest algorithm)

B.      STABLE Tachycardia

a.      Wide QRS

                                                              i.      Regular rythm

A.      If ventricular tachycardia or uncertain rhythm

1.      Give Amiodarone 150 mg IV over 10 min (repeat as needed to maximum dose of 2.2g/24hrs

2.      Prepare for elective synchronized cardioversion

B.      If SVT with aberrancy give Adenosine 6 mg rapid IV PUSH, may repeat 12 mg dose once +20cc PNSS

 

                                                            ii.      Irregular rythm

A.      If atrial fibrillation with aberrancy (Follow procedures in Irregular Narrow Complex Tachycardia)

B.      If preexcited atrial fibrillation (AF+WPW)

1.      Consult experts advise

2.      Avoid AV Nodal Blocking agents:  Adenosine, digoxin, diltiazem, verapamil

3.      Consider anti-arrythmics: like Amiodarone 150 mg IV over 10 minutes

 

C.      If recurrent polymorphic VT, seek expert consultation

D.     IF Torsades de pointes: Give Magnesium, Load with 1-2 g over 5-60 min infused in D5Water over 1-2 hours

b.      Narrow QRS

                                                              i.      Regular rythm Narrow Complex Tachycardia

A.      Attempt vagal maneuvers

B.      Give adenosine  6 mg rapid IV PUSH, may repeat 12 mg dose once +20cc PNSS

1.      Rythm Converts

                                                                                                                                      i.      Probable re-entry of Supraventricular Tachycardia

1.      Observe for recurrence

2.      Treat recurrence with adenosine or longer acting AV Nodal blocking agents such as: Diltiazem, Beta blockers

2.      Rythm Does not convert

                                                                                                                                      i.      Possible Atrial flutter, Ectopic atrial tachycardia, or junctional tachycardia

1.      Control rate with diltiazem, beta blockers (use beta blockers with caution because of risk of pulmonary disease or CHF)

2.      Treat underlying cause

3.      Consider expert consultation

                                                            ii.      Irregular rythm Narrow Complex Tachycardia

A.      Probable atrial fibrillation, atrial flutter or Multifocal Atrial Tachycardia

1.      Control rate with diltiazem, beta blockers (use beta blockers with caution because of risk of pulmonary disease or CHF)

2.      Treat underlying cause

3.      Consider expert consultation

C.      Energy selection in Synchronized Cardioversion:

D.     PSVT (Paroxysmal Supraventricular Tachycardia):  50 J, 100J, 200J, 300J, 360J

E.      VT (Ventricular Tachycardia): 100J, 200 J, 300J, 360J

F.       Polymorphic VT (treat like VF) : 200J, 200-300J, 360J

G.     Atrial Flutter: 50J, 100J, 200 J, 300J, 360J

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