Tachycardia resident survival guide: Difference between revisions

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__NOTOC__
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{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}; [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}; [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#FIRE: Focused Initial Rapid Evaluation|FIRE]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#FIRE: Focused Initial Rapid Evaluation|FIRE]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#Complete Diagnostic Approach|Diagnosis]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#Treatment|Treatment]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#Do's|Do's]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[{{PAGENAME}}#Dont's|Dont's]]
|}
|}


==Overview==
==Overview==
[[Tachycardia]] is a form of [[cardiac arrhythmia]] which refers to a rapid beating of the [[heart]]. By convention the term refers to [[heart rate]]s greater than 100 beats per minute in the [[adult]] patient. Heart rate typically greater than 150 beats per minute in tachyarrhythmia. <ref>{{Cite journal| doi = 10.1161/CIRCULATIONAHA.110.970988| issn = 1524-4539| volume = 122| issue = 18 Suppl 3| pages = –729-767| last1 = Neumar| first1 = Robert W.| last2 = Otto| first2 = Charles W.| last3 = Link| first3 = Mark S.| last4 = Kronick| first4 = Steven L.| last5 = Shuster| first5 = Michael| last6 = Callaway| first6 = Clifton W.| last7 = Kudenchuk| first7 = Peter J.| last8 = Ornato| first8 = Joseph P.| last9 = McNally| first9 = Bryan| last10 = Silvers| first10 = Scott M.| last11 = Passman| first11 = Rod S.| last12 = White| first12 = Roger D.| last13 = Hess| first13 = Erik P.| last14 = Tang| first14 = Wanchun| last15 = Davis| first15 = Daniel| last16 = Sinz| first16 = Elizabeth| last17 = Morrison| first17 = Laurie J.| title = Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care| journal = Circulation| date = 2010-11-02| pmid = 20956224}}</ref>
[[Tachycardia]] is a form of [[cardiac arrhythmia]] which refers to a rapid beating of the [[heart]]. By convention the term refers to [[heart rate]]s greater than 100 beats per minute in the [[adult]] patient. Heart rate typically greater than 150 beats per minute in tachyarrhythmia.<ref>{{Cite journal| doi = 10.1161/CIRCULATIONAHA.110.970988| issn = 1524-4539| volume = 122| issue = 18 Suppl 3| pages = –729-767| last1 = Neumar| first1 = Robert W.| last2 = Otto| first2 = Charles W.| last3 = Link| first3 = Mark S.| last4 = Kronick| first4 = Steven L.| last5 = Shuster| first5 = Michael| last6 = Callaway| first6 = Clifton W.| last7 = Kudenchuk| first7 = Peter J.| last8 = Ornato| first8 = Joseph P.| last9 = McNally| first9 = Bryan| last10 = Silvers| first10 = Scott M.| last11 = Passman| first11 = Rod S.| last12 = White| first12 = Roger D.| last13 = Hess| first13 = Erik P.| last14 = Tang| first14 = Wanchun| last15 = Davis| first15 = Daniel| last16 = Sinz| first16 = Elizabeth| last17 = Morrison| first17 = Laurie J.| title = Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care| journal = Circulation| date = 2010-11-02| pmid = 20956224}}</ref>


==[[Tachycardia classification|Classification]]==
==[[Tachycardia classification|Classification]]==
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{{familytree/end}}
{{familytree/end}}
''Algorithm based on the 2003 [[ACLS]] guidelines for the management of tachycardia.''<ref name="pmid14563598">{{cite journal| author=Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ et al.| title=ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2003 | volume= 42 | issue= 8 | pages= 1493-531 | pmid=14563598 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14563598  }} </ref>
''Algorithm based on the 2003 [[ACLS]] guidelines for the management of tachycardia.''<ref name="pmid14563598">{{cite journal| author=Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ et al.| title=ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2003 | volume= 42 | issue= 8 | pages= 1493-531 | pmid=14563598 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14563598  }} </ref>
==Causes==
===Acute treatable causes of tachycardia===
====H's====
*Hypoxia
*Hypovolemia
*Hydrogen ion (acidosis)
*Hypo-/hyperkalemia
*Hypothermia
====T's====
*Toxins
*Tamponade (cardiac)
*Tension pneumothorax
*Thrombosis, pulmonary
*Thrombosis, coronary<ref name="pmid20956224">{{cite journal| author=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.| title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S729-67 | pmid=20956224 | doi=10.1161/CIRCULATIONAHA.110.970988 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956224  }} </ref>


==FIRE: Focused Initial Rapid Evaluation==
==FIRE: Focused Initial Rapid Evaluation==
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
{{familytree/start |summary=Sample 1}}
{{familytree/start}}
{{familytree | | | | | | | | A01 |A01=[[Tachycardia]]}}
{{familytree | | | | | | | | | | | | | A01 | | | | A01=[[Tachycardia]] }}
{{familytree | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | |!| | | | | | }}
{{familytree | | | | | | | | B01 |-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-| B02 | B01=Pulse| B02=No Pulse}}
{{familytree | | | | | | | | | |,|-|-|-|^|-|-|-|.| | }}
{{familytree | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | |!| }}  
{{familytree | | | | | | | | | B01 | | | | | | B02 | B01=Pulse | B02=No Pulse }}
{{familytree | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | C01| C01=[[ACLS]]}}  
{{familytree | | | | | | | | | |!| | | | | | | |!| | }}
{{familytree | | | | | | | | D01 | | | | | | | | | | | | | | | | | | | | | | | | | D01='''<u>Evaluate and treat instability:</u> <br> 12-lead ECG, don't delay therapy <br> IV/IO access <br> Ventilation <br> Oxygenation <br> Heart rate <br> Blood pressure <br> Acute altered mental status <br> Signs of shock <br> Ischemic chest discomfort <br> Acute heart failure'''}}
{{familytree | | | | | | | | | X01 | | | | | | X02 | X01=<b>Evaluate and treat instability:</b> |X02=<b>Pulseless VT or PEA</b>}}
{{familytree | | | | | | | | |!| | | | | | | | }}
{{familytree |boxstyle=border-top: 0px | | | | | | | | | C01 | | | | | | C02 | C01=<div style="text-align: left;">
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
❑&nbsp;&nbsp;12-lead ECG, don't delay therapy <BR>
{{familytree | | | E01 | | | | | | | | E02 | | | E01=Hemodynamicaly stable| E02=Hemodynamicaly unstable}}
❑&nbsp;&nbsp;IV/IO access <BR>
{{familytree | | | |!| | | | | | | | | |!| }}
❑&nbsp;&nbsp;Check Ventilation <BR>
{{familytree | | | |!| | | | | | | | | F01 | F01='''<u>Synchronized cardioversion:</u> <br> Consider sedation <br> If regular narrow complex, consider adenosine}}
❑&nbsp;&nbsp;Supplementary oxygen if hypoxemic <BR>
{{familytree | | | G01 | | | | | | | G01=Check duration of QRS }}
❑&nbsp;&nbsp;Check heart rate and blood pressure <BR>
{{familytree | |,|-|^|.| | | | | | | | | | }}
❑&nbsp;&nbsp;Check signs of end-organ [[hypoperfusion|<span style="color: #000000;">hypoperfusion</span>]] <BR>
{{familytree | H01 | | H02 | | | | | | | | | H01=QRS wider than 0.12 seconds| H02=QRS narrower than 0.12 seconds}}
: ❑&nbsp;&nbsp;[[Altered mental status|<span style="color: #000000;">Altered mental status</span>]] <BR>
{{familytree | |!| | | |!| | | | | | | | | | | }}
: ❑&nbsp;&nbsp;[[Cold extremities|<span style="color: #000000;">Cold extremities</span>]] <BR>
{{familytree | I01 | | I02 | | | | | | | | I01=Consider expert consultation <br> Consider antiarrhythmic infusion <br> Consider adenosine only if monomorphic and regular |I02=Vagal maneuvers <br> Beta-Blockers or calcium channel blocker <br> Consider expert consultation <br> Adenosine if regular}}
: ❑&nbsp;&nbsp;[[Cyanosis|<span style="color: #000000;">Cyanosis</span>]] <BR>
{{familytree | | | | | | | | | | | | | | | | }}
: ❑&nbsp;&nbsp;[[Oliguria|<span style="color: #000000;">Oliguria</span>]] ([[urine output|<span style="color: #000000;">urine output</span>]] &lt;0.5 mL/kg/h) <BR>
{{familytree | | | | | | | | | | | | | }}
: ❑&nbsp;&nbsp;Sustained [[hypotension|<span style="color: #000000;">hypotension</span>]] (≥30 min) <BR>
:: ❑&nbsp;&nbsp;[[SBP|<span style="color: #000000;">SBP</span>]] &lt;90 mm Hg ''or'' <BR>
:: ❑&nbsp;&nbsp;[[MAP|<span style="color: #000000;">MAP</span>]] ↓ &gt;30 mm Hg below baseline <BR>
❑&nbsp;&nbsp;Ischemic chest discomfort <BR>
❑&nbsp;&nbsp;Acute heart failure</div>| C02=[[Cardiac arrest resident survival guide#Cardiac Arrest Care: Algorithm 2|Proceed to<BR>ACLS Cardiac Arrest Algorithm]]}}
{{familytree | | | | | | | | | |!| | | | | | | | | | }}
{{familytree | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}
{{familytree | | | | | D01 | | | | | | D02 | | | | | D01=Hemodynamic stable|D02=Hemodynamic unstable}}
{{familytree |boxstyle=border-top: 0px | | | | | E01 | | | | | | E02 | | | | | E01=Check QRS-duration|E02=<b><u>Synchronized cardioversion:</u></b> <br><div style="text-align: left;">
❑&nbsp;&nbsp;Consider sedation <br>
❑&nbsp;&nbsp;If regular narrow complex, consider adenosine</div>| F02=<b><u>Doses/details of synchronized cardioversion:</u></b> <br>
❑&nbsp;&nbsp;Narrow regular: 50-100 Joule <br>
❑&nbsp;&nbsp;Narrow irregular: 120-200 Joule biphasic or 200 Joule monophasic <br>
❑&nbsp;&nbsp;Wide regular: 100 Joule <br>
❑&nbsp;&nbsp;Wide irregular: defibrillation dose (Not synchronized) <br>
<b><u>Adenosine IV dose:</u></b> <br>
❑&nbsp;&nbsp;First dose: 6mg rapid IV push; follow with NS flush <br>
❑&nbsp;&nbsp;Second dose: 12mg if required}}
{{familytree | | | | | |!| | | | | | | |!| | | | | | }}
{{familytree | | | | | |!| | | | | | | F03 | | | | | | F03 =<div style="text-align: left;">
❑&nbsp;&nbsp;<u>Doses/details of synchronized cardioversion:</u> <br>
: ❑&nbsp;&nbsp;Narrow regular: 50-100 Joule <br>
: ❑&nbsp;&nbsp;Narrow irregular: 120-200 Joule biphasic or 200 Joule monophasic <br>
: ❑&nbsp;&nbsp;Wide regular 100 Joule <br>
: ❑&nbsp;&nbsp;Wide irregular: defibrillation dose (Not synchronized) <br>
❑&nbsp;&nbsp;<u>Adenosine IV dose:</u> <br>
: ❑&nbsp;&nbsp;First dose: 6mg rapid IV push; follow with NS flush <br>
: ❑&nbsp;&nbsp;Second dose: 12mg if required</div>}}
{{familytree | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}
{{familytree | |!| | | | | | | |!| | | |!| | | | | }}
{{familytree | F01 | | | | | | F02 | | G03 |   F01=[[Wide complex tachycardia|Wide complex tachycardia (≥120 ms)]]|F02=[[Narrow complex tachycardia|Narrow complex tachycardia (<120 ms)]] | G03=[[Hemodynamic instability|Proceed to Hemodynamic instability resident survival guide]]}}
{{familytree | |!| | | | | | | |!| | | | | | | | | }}
{{familytree | G01 | | | | | | G02 | | | | | G01=Consider expert consultation <br> Consider antiarrhythmic infusion <br> Consider adenosine only if monomorphic and regular|G02=Vagal maneuvers (No carotic sinus massage in patients with recent transient ischemic attack/stroke/ipsilateral significant carotid artery stenosis/carotid artery bruit)<ref name="pmid16418451">{{cite journal| author=Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA et al.| title=AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. | journal=Circulation | year= 2006 | volume= 113 | issue= 2 | pages= 316-27 | pmid=16418451 | doi=10.1161/CIRCULATIONAHA.105.170274 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16418451  }} </ref> <br> Beta-Blockers or calcium channel blocker <br> Consider expert consultation <br> Adenosine if regular}}
{{familytree | |!| | | | | | | |!| | | | | | | | | | }}
{{familytree | |!| | | | | | | H02 | | | | | | | | | |H02=[[Narrow complex tachycardia resident survival guide|Proceed to Narrow complex tachycardia resident survival guide]]}}
{{familytree | H01 | | | | | | | | | | | | | | | | | H01=<div style="text-align: left;">
❑&nbsp;&nbsp;<u>Antiarrhythmic infusion for stable wide-QRS tachycardia:</u> <br>
: ❑&nbsp;&nbsp;Procainamide IV Dose: <br>
:: ❑&nbsp;&nbsp;20-50mg/min until: <br>
::: ❑&nbsp;&nbsp;Arrhythmia suppressed <br>
::: ❑&nbsp;&nbsp;Hypotension ensues <br>
::: ❑&nbsp;&nbsp;QRS duration increases 50% <br>
::: ❑&nbsp;&nbsp;Maximum dose 17mg/kg given. <br>
:: ❑&nbsp;&nbsp;Maintenance infusion: 1-4 mg/min. <br>
:: ❑&nbsp;&nbsp;Avoid if prolonged QT or CHF. <br>
: ❑&nbsp;&nbsp;Amiodarone IV Dose: <br>
:: ❑&nbsp;&nbsp;First dose: 150mg over 10 minutes. Repeat as needed if VT recurs. <br>
:: ❑&nbsp;&nbsp;Follow by maintenance infusion by 1mg/min for first 6 hours. <br>
: ❑&nbsp;&nbsp;Sotalol IV Dose: <br>
:: ❑&nbsp;&nbsp;100mg (1.5mg/kg) over 5 minutes. <br>
:: ❑&nbsp;&nbsp;Avoid if prolonged QT.</div>}}
 
{{familytree | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | I01 | | | | | | | | | | | | | | | | | I01=[[Wide complex tachycardia resident survival guide|Proceed to Wide complex tachycardia resident survival guide]]}}
{{familytree/end}}
{{familytree/end}}
''Algorithm based on the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.''<ref name="pmid20956224">{{cite journal| author=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.| title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S729-67 | pmid=20956224 | doi=10.1161/CIRCULATIONAHA.110.970988 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956224  }} </ref>
''Algorithm based on the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.''<ref name="pmid20956224">{{cite journal| author=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.| title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S729-67 | pmid=20956224 | doi=10.1161/CIRCULATIONAHA.110.970988 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956224  }} </ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
</div>


[[Category:Disease]]
[[Category:Disease]]
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Primary care]]
[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
</div>

Latest revision as of 00:23, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]; Priyamvada Singh, M.D. [3]

Tachycardia resident survival guide Microchapters
Overview
Classification
Causes
FIRE

Overview

Tachycardia is a form of cardiac arrhythmia which refers to a rapid beating of the heart. By convention the term refers to heart rates greater than 100 beats per minute in the adult patient. Heart rate typically greater than 150 beats per minute in tachyarrhythmia.[1]

Classification

 
 
 
 
 
 
 
 
 
 
 
Tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Narrow complex tachycardia (SVT)
 
 
 
 
 
 
 
 
 
 
 
Wide complex tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The origin of the impulse:
Atria
 
 
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Atria or AV junction
 
The origin of the impulse:
AV junction
 
The origin of the impulse:
Atria, AV junction or ventricles

Presence of an accessory pathway
 
The origin of the impulse:
Pacemaker
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Atrial fibrillation
Atrial flutter
Ectopic atrial rhythm
Multifocal atrial tachycardia (MAT)
Paroxysmal atrial tachycardia (PAT) with block
Premature atrial contractions (PAC)
Sinus tachycardia
Wandering atrial pacemaker
Sick sinus syndrome
 
AVNRT

AVRT (accessory pathway):
- Wolff-Parkinson-White syndrome (WPW)
- Lown-Ganong-Levine syndrome (LGL)
 
Accelerated junctional rhythm
 
SVTAC
(SVT with aberrant conduction):

Left bundle branch block
Left anterior hemi-block
Lefo posterior hemi-block
Right bundle branch block
Trifascicular block
 
Ventricular tachycardia
Ventricular fibrillation
Ventricular parasystole
 
Wolff-Parkinson-White syndrome (WPW)
Lown-Ganong-Levine syndrome (LGL)
 
Pacemaker-mediated tachycardia
Runaway pacemaker syndrome
Sensor induced tachycardia

Algorithm based on the 2003 ACLS guidelines for the management of tachycardia.[2]

Causes

Acute treatable causes of tachycardia

H's

  • Hypoxia
  • Hypovolemia
  • Hydrogen ion (acidosis)
  • Hypo-/hyperkalemia
  • Hypothermia

T's

  • Toxins
  • Tamponade (cardiac)
  • Tension pneumothorax
  • Thrombosis, pulmonary
  • Thrombosis, coronary[3]

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

 
 
 
 
 
 
 
 
 
 
 
 
Tachycardia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulse
 
 
 
 
 
No Pulse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate and treat instability:
 
 
 
 
 
Pulseless VT or PEA
 
 
 
 
 
 
 
 

❑  12-lead ECG, don't delay therapy
❑  IV/IO access
❑  Check Ventilation
❑  Supplementary oxygen if hypoxemic
❑  Check heart rate and blood pressure
❑  Check signs of end-organ hypoperfusion

❑  Altered mental status
❑  Cold extremities
❑  Cyanosis
❑  Oliguria (urine output <0.5 mL/kg/h)
❑  Sustained hypotension (≥30 min)
❑  SBP <90 mm Hg or
❑  MAP ↓ >30 mm Hg below baseline

❑  Ischemic chest discomfort

❑  Acute heart failure
 
 
 
 
 
Proceed to
ACLS Cardiac Arrest Algorithm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemodynamic stable
 
 
 
 
 
Hemodynamic unstable
 
 
 
 
 
 
 
 
Check QRS-duration
 
 
 
 
 
Synchronized cardioversion:

❑  Consider sedation

❑  If regular narrow complex, consider adenosine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

❑  Doses/details of synchronized cardioversion:

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

❑  Adenosine IV dose:

❑  First dose: 6mg rapid IV push; follow with NS flush
❑  Second dose: 12mg if required
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wide complex tachycardia (≥120 ms)
 
 
 
 
 
Narrow complex tachycardia (<120 ms)
 
Proceed to Hemodynamic instability resident survival guide
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider expert consultation
Consider antiarrhythmic infusion
Consider adenosine only if monomorphic and regular
 
 
 
 
 
Vagal maneuvers (No carotic sinus massage in patients with recent transient ischemic attack/stroke/ipsilateral significant carotid artery stenosis/carotid artery bruit)[4]
Beta-Blockers or calcium channel blocker
Consider expert consultation
Adenosine if regular
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proceed to Narrow complex tachycardia resident survival guide
 
 
 
 
 
 
 
 
 

❑  Antiarrhythmic infusion for stable wide-QRS tachycardia:

❑  Procainamide IV Dose:
❑  20-50mg/min until:
❑  Arrhythmia suppressed
❑  Hypotension ensues
❑  QRS duration increases 50%
❑  Maximum dose 17mg/kg given.
❑  Maintenance infusion: 1-4 mg/min.
❑  Avoid if prolonged QT or CHF.
❑  Amiodarone IV Dose:
❑  First dose: 150mg over 10 minutes. Repeat as needed if VT recurs.
❑  Follow by maintenance infusion by 1mg/min for first 6 hours.
❑  Sotalol IV Dose:
❑  100mg (1.5mg/kg) over 5 minutes.
❑  Avoid if prolonged QT.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proceed to Wide complex tachycardia resident survival guide
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Algorithm based on the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.[3]

References

  1. Neumar, Robert W.; Otto, Charles W.; Link, Mark S.; Kronick, Steven L.; Shuster, Michael; Callaway, Clifton W.; Kudenchuk, Peter J.; Ornato, Joseph P.; McNally, Bryan; Silvers, Scott M.; Passman, Rod S.; White, Roger D.; Hess, Erik P.; Tang, Wanchun; Davis, Daniel; Sinz, Elizabeth; Morrison, Laurie J. (2010-11-02). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): –729-767. doi:10.1161/CIRCULATIONAHA.110.970988. ISSN 1524-4539. PMID 20956224.
  2. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ; et al. (2003). "ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society". J Am Coll Cardiol. 42 (8): 1493–531. PMID 14563598.
  3. 3.0 3.1 Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW; et al. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
  4. Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA; et al. (2006). "AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society". Circulation. 113 (2): 316–27. doi:10.1161/CIRCULATIONAHA.105.170274. PMID 16418451.