TACHYCARDIA > 150min
(SVT, A.fib, A.flut)
a) Unstable Tachycardia (SVT, A.fib, A.flut)
Airway, O2, IV
Consider trial of meds
Synchronized cardioversion 50-100 J
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Synchronized cardioversion 200 J
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Synchronized cardioversion 300 J
b) Stable Tachycardia (SVT, A.fib, A.flut) Airway, oxygen, IV
Vagal maneuvers
If SVT is considered
Adenosine 6 mg rapid IV, wait 1-2 min
Adenosine 12 mg rapid IV, wait 1-2 min. Repeat same dose
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If no response and it remains narrow complex tachycardia
CCB (e.g. Verapamil, Diltiazem), B-Blocker, Dig
If tachycardia is A.fib, A.flut, consider
CCB (e.g. Verapamil, Diltiazem), B-Blocker, Dig or
Synchronized Cardioversion Consider Procainamide or Amiodarone or Sotalol
Note: assure no WPW is present since CCB, B-Blockers and Dig are class III , i.e. harmful
Note:
this algorithm applies only for Rate Control and Stabilization and not for Rhythm
Conversion. In case of latter considerAmiodarone or Procainamide or Flecainide
c)
Stable Wide Complex Tachycardia of questionable etiology
Airway, oxygen, IV
Lidocaine 1-1.5 mg/kq IV. Then 0.5-0.75 mg/kg IV q5-1O min to total 3 mg/kg
or Amiodarone 150 mg IV over 10 min. May repeat in 10 min as needed *
Adenosine 6 mg rapid IV, wait 1-2 min
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Adenosine 12 mg rapid IV, wait 1-2 min. Repeat same dose
Procainamide 20-30 mg/min IV to max 17 mg/kg
Consider sync. cardioversion 100 – 200 – 300 – 360j *See maintenance dosage for Amiodarone in chapter of "