ACLS.net ACLS 2005
Tachycardia Algorithm
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The following directs AHA accepted actions after tachycardia with symptoms due to the fast rate is discovered: Start the Secondary ABCDs with emphasis on oxygenation, IV, VS, and EKG, and consider the following questions:
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| Yes 1-2-3, think SVT, then V-A-C |
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↓ |
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Vagal maneuvers, if this fails.. |
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↓ |
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Adenosine 6mg rapid IV push
(may repeat x2, q1-2min. at 12mg) |
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↓ |
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Cardizem (diltiazem) managed by an expert if
stable, narrow, regular tachyarrhythmia continues |
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Perform immediate electrical cardioversion if a patient becomes unstable at any time. For sinus tachycardia consider possible causes and treat accordingly. |
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| Consult an Expert |
Most stable tachycardia rhythms require management by an expert due to the challenge of accurately determining and safely treating tachyarrhythmias. A sampling of rhythms and possible expert interventions are listed below. |
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Stable Narrow Irregular Tachycardia
Atrial Fibrillation, Multifocal Atrial Tachycardia, possibly Atrial Flutter
Rate Control: diltiazem or beta blocker |
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Stable Narrow Regular Tachycardia
Recurrent SVT, Atrial Flutter, Junctional or Ectopic Atrial Tachycardia
Rate Control: diltiazem or beta blocker |
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Stable Wide Irregular Tachycardia
(Avoid calcium channel blockers and digoxin due to possible AF+WPW)
Consider amiodarone. Magnesium 2g IV over 5min. for torsades |
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Stable Wide Regular Tachycardia
If VT, amiodarone 150mg IV over 10min. repeat prn (max 2.2g IV/24hr),
elective synchronized cardioversion |
