ACLS: Tachycardia: Difference between revisions
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# [[SVT]] | # [[SVT]] | ||
##Vagal maneuvers (convert up to 25%) | ##Vagal maneuvers (convert up to 25%) | ||
##Adenosine 6mg IVP (can follow with 12mg if initially fails) | ##[[Adenosine]] 6mg IVP (can follow with 12mg if initially fails) | ||
###If adenosine fails initiate rate control with CCB or BB | ###If [[adenosine]] fails initiate rate control with CCB or BB | ||
####Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr | ####[[Diltiazem]] 15-20mg IV, followed by infusion of 5-15mg/hr | ||
####Metoprolol 5mg IVP x 3 followed by 50mg PO | ####Metoprolol 5mg IVP x 3 followed by 50mg PO | ||
##Synchronized [[Cardioversion]] (50-100J) | ##Synchronized [[Cardioversion]] (50-100J) | ||
| Line 23: | Line 23: | ||
# [[A fib]] / A Flutter w/ variable conduction | # [[A fib]] / A Flutter w/ variable conduction | ||
##Rate control with: | ##Rate control with: | ||
###Dilt | ###[[Dilt]] | ||
###MTP (good in setting of ACS) | ###MTP (good in setting of ACS) | ||
###Amiodarone (good in setting of hypotension, CHF) | ###[[Amiodarone]] (good in setting of hypotension, CHF) | ||
###Digoxin (good in setting of CHF) | ###[[Digoxin]] (good in setting of CHF) | ||
##Synchronized [[Cardioversion]] (120-200 J) | ##Synchronized [[Cardioversion]] (120-200 J) | ||
| Line 36: | Line 36: | ||
*If stable: | *If stable: | ||
**Meds | **Meds | ||
***Procainamide | ***[[Procainamide]] | ||
****20-50mg/min; then maintenance infusion of 1mg/min x6hr | ****20-50mg/min; then maintenance infusion of 1mg/min x6hr | ||
****Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given | ****Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given | ||
****Avoid if prolonged QT or CHF | ****Avoid if prolonged QT or CHF | ||
***Amiodarone | ***[[Amiodarone]] | ||
****150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr | ****150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr | ||
***Adenosine | ***[[Adenosine]] | ||
****May be considered for diagnosis and treatment only if rhythm is regular and monomorphic | ****May be considered for diagnosis and treatment only if rhythm is regular and monomorphic | ||
**Synchronized [[Cardioversion]] (100J) | **Synchronized [[Cardioversion]] (100J) | ||
Revision as of 19:34, 10 March 2012
3 questions
- Is the pt in a sinus rhythm?
- Is the QRS wide or narrow?
- Is the rhythm regular or irregular?
Narrow
Narrow Regular
- See also Tachycardia (Narrow)
- Sinus Tachycardia
- Treat underlying cause
- SVT
- Vagal maneuvers (convert up to 25%)
- Adenosine 6mg IVP (can follow with 12mg if initially fails)
- Synchronized Cardioversion (50-100J)
Narrow Irregular
- MAT
- Treat underlying cause (hypoK, hypomag)
- Sinus Tachycardia w/ frequent PACs
- A fib / A Flutter w/ variable conduction
- Rate control with:
- Dilt
- MTP (good in setting of ACS)
- Amiodarone (good in setting of hypotension, CHF)
- Digoxin (good in setting of CHF)
- Synchronized Cardioversion (120-200 J)
- Rate control with:
Wide
Wide Regular
- If pulseless: shock (unsynchronized 200J)
- If unstable: shock (synchronized 100J)
- Hypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
- If stable:
- Meds
- Procainamide
- 20-50mg/min; then maintenance infusion of 1mg/min x6hr
- Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given
- Avoid if prolonged QT or CHF
- Amiodarone
- 150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
- Adenosine
- May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
- Procainamide
- Synchronized Cardioversion (100J)
- Meds
Wide Irregular
- DO NOT use AV nodal blockers
- Can precipitate V-Fib
- A fib w/ preexcitation
- 1st line - Electric cardioversion
- 2nd line - Procainamide, amiodarone, or sotalol
- A fib w/ aberrancy
- Polymorphic V-Tach / Torsades
- Emergent defibrillation (NOT synchronized)
- Correct electrolyte abnormalities
- HypoK, hypoMag
- Stop prolonged QT meds
See Also
Source
2010 AHA ACLS Guidelines