Algorithms
Adult ACLS
Adult Tachycardia with a Pulse
Decide unstable vs stable, then narrow vs wide QRS. Unstable patients get synchronized cardioversion; stable patients get vagal maneuvers, adenosine, or antiarrhythmics.
Interactive pathway
- Assess
Assess appropriateness for clinical condition
- Heart rate typically ≥ 150/min if tachyarrhythmia
- Rates < 150 are usually a response to something else
- Action
Identify and treat the underlying cause
- Maintain patent airway; assist breathing as necessary
- Oxygen if hypoxemic
- Cardiac monitor, blood pressure, oximetry
- IV access
- 12-lead ECG if available; don't delay therapy
- Decision
Persistent tachyarrhythmia causing instability?
Hypotension · acutely altered mental status · signs of shock · ischemic chest discomfort · acute heart failure