Tachycardia resident survival guide
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 |
| Diagnosis |
| Treatment |
| Do's |
| Dont's |
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
Algorithm based on the 2003 ACLS guidelines for the management of tachycardia.[2]
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ACLS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Evaluate and treat instability: 12-lead ECG, don't delay therapy IV/IO access Ventilation Oxygenation (if hypoxemic provide supplementary oxygen) Heart rate Blood pressure Acute altered mental status Signs of shock Ischemic chest discomfort Acute heart failure | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hemodynamicaly stable | Hemodynamicaly unstable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check duration of QRS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Wide complex tachycardia | Narrow complex tachycardia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consider expert consultation Consider antiarrhythmic infusion Consider adenosine only if monomorphic and regular | Vagal maneuvers Beta-Blockers or calcium channel blocker Consider expert consultation Adenosine if regular | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antiarrhythmic infusion for stable wide-QRS tachycardia: Procainamide IV Dose: 20-50mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases 50%, or maximum dose 17mg/kg given. Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF. Amiodaron 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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Algorithm based on the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.[3]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.