2 Establish and Treat Possible Causes Adenosine 6 mg rapid IV push, follow with NS flush 2nd Dose: 12 mg Adult Tachycardia (with Pulse) Secure patient airway, assist with respirations as needed Administer oxygen if hypoxic Attach cardiac monitor, monitor BP and SPO2 1 Identify SVT (Heart rate >150) Synchronized Cardioversion Starting Doses: Antiarrhythmic Infusions (Stable Wide-Complex) Amiodarone: 150 mg over 10 min Repeat as necessary if VT recurs Procainamide: 20-50 mg/min until arrhythmia is suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose of 17 mg/kg is reached Sotalol: 100 mg (1.5 mg/kg) over 5 min 3 Hypotension? Shock? Ischemic Chest Pain? AMS? Heart Failure? 4 QRS Wide? (> 0.12 sec) No 5 Immediate Synchronized Cardioversion Yes If regular narrow complex, consider Adenosine _ 6 Establish vascular access Run 12-Lead ECG if possible Consider adenosine only if monomorphic and regular Consider antiarrhythmic infusion Seek expert consult 7 Establish vascular access Run 12-Lead ECG if possible Consider vagal maneuvers Adenosine (if regular rhythm) Administer -Blocker or Calcium Channel Blocker Seek expert consult No Yes Narrow regular: 50-100 J Narrow irregular: 120-200 J biphasic or 200 J monophasic Wide regular: 100 J Wide irregular: defibrillation dose (Not synchronized)
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2 Establish and TreatPossible Causes
Adenosine 6 mg rapid IV push, follow with NS flush
2nd Dose: 12 mg
Adult Tachycardia (with Pulse)
Secure patient airway, assist with respirations as neededAdminister oxygen if hypoxicAttach cardiac monitor, monitor BP and SPO2
1 Identify SVT(Heart rate >150)
Synchronized CardioversionStarting Doses:
Antiarrhythmic Infusions(Stable Wide-Complex)
Amiodarone: 150 mg over 10 min Repeat as necessary if VT recurs
Procainamide: 20-50 mg/min until arrhythmia is suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose of 17 mg/kg is reached
Sotalol: 100 mg (1.5 mg/kg) over 5 min
3 Hypotension?Shock?
Ischemic Chest Pain?AMS?
Heart Failure?
4 QRS Wide?(> 0.12 sec)
No
5 Immediate SynchronizedCardioversion
Yes
If regular narrow complex, consider Adenosine
_
6 Establish vascular accessRun 12-Lead ECG if possibleConsider adenosine only if monomorphic and regularConsider antiarrhythmic infusionSeek expert consult
7 Establish vascular accessRun 12-Lead ECG if possibleConsider vagal maneuversAdenosine (if regular rhythm)Administer -Blocker or Calcium Channel BlockerSeek expert consult
No
Yes
Narrow regular: 50-100 JNarrow irregular: 120-200 J biphasic or 200 J monophasicWide regular: 100 JWide irregular: defibrillation dose (Not synchronized)
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