ACLS.net Tachycardia Algorithms

ACLS.net ACLS 2005 Tachycardia Algorithms

By using this site you agree to the terms and conditions.

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:

1. Stable?	Yes ↓ next question	No, unstable = Immediate electrical cardioversion

2. Narrow?	Yes ↓ next question	No, wide = Consult an expert (QRS ≥0.12 sec)

3. Regular?	Yes ↓ see mnemonic	No, irregular = Consult an expert

Yes 1-2-3, think SVT, then V-A-C
		↓
	Vagal maneuvers, if this fails..
		↓
	Adenosine 6mg rapid IV push (may repeat x2, q1-2min. at 12mg)
		↓
	Cardizem (diltiazem) managed by an expert if stable, narrow, regular tachyarrhythmia continues

Perform immediate electrical cardioversion if a patient becomes unstable at any time. For sinus tachycardia consider possible causes and treat accordingly.

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.

Stable Narrow Irregular Tachycardia
Atrial Fibrillation, Multifocal Atrial Tachycardia, possibly Atrial Flutter
Rate Control: diltiazem or beta blocker

Stable Narrow Regular Tachycardia
Recurrent SVT, Atrial Flutter, Junctional or Ectopic Atrial Tachycardia
Rate Control: diltiazem or beta blocker

Stable Wide Irregular Tachycardia
(Avoid calcium channel blockers and digoxin due to possible AF+WPW)
Consider amiodarone. Magnesium 2g IV over 5min. for torsades

Stable Wide Regular Tachycardia
If VT, amiodarone 150mg IV over 10min. repeat prn (max 2.2g IV/24hr),
elective synchronized cardioversion