Sequence of Tachycardia
Refer the flowchart mentioned below to get a clear idea about the management of adult tachycardia.
Tachycardia is referred to a heart rate more than 100 beats per minute (BPM).It is faster than normal heart rate.
Generally, Tachycardia is classified as follows:
- Narrow complex- In narrow complex tachycardia, QRS is less than 0.12 seconds on ECG.
- Wide complex- On ECG reports, QRS is found to be more than 0.12 seconds in wide complex tachycardia.
The following measures can be used during the treatment of Emergency tachycardia:
- Synchronized cardioversion
- Vagal Maneuvers
- Drugs include:
As soon as tachycardia is found in patients during cardiac monitoring, the following tachycardia sequence should be followed:
- Recognize and treat the underlying cause.
- Examine the heart rate, rhythm and blood pressure.
- Ensure oxygenation more than 94%.
- Find out whether the tachycardia is stable or unstable. Altered level of consciousness, symptoms of shock or chest pain and hypotension may be found due to unstable tachycardia.
Also read: ACLS Algorithm: Adult Cardiac Arrest
If unstable tachycardia is found in patients, then synchronized cardioversion should be performed without any delay.
- For narrow and regular QRS: cardiovert at 50-100 Joules.
- For narrow and irregular QRS: cardiovert at 120-200 Joules.
- For wide and regular QRS: cardiovert at 100 Joules.
- For wide and irregular QRS: turn off the synchronized mode and defibrillate.
If stable tachycardia is found in patients, then an IV or IO access for fluid and medication administration should be established.
- Establish an IV or IO access for fluid and medication administration.
- Adenosine should be given as 6 mg bolus form and if necessary, a second dose of 12 mg may be if given.
- If Adenosine is not found effective; in this case, Procainamide may be given at a dose of 20-50 mg with a maximum dose of 17 mg/kg and infusion of 1-4 mg/minutes is considered as maintenance dose or Amiodarone 150 mg over 10 minutes may be used with a second dose for recurrent Ventricular Tachycardia followed by infusion of 1 mg/min.
- Adenosine should be used for regular and QRS interval more than 0.12 seconds.
- An antiarrhythmic infusion should be considered.
Also read: ACLS Algorithm: Acute Coronary Syndrome
Keep following PrepLadder!