Tachycardia is a faster than normal heart rhythm that is usually classified as narrow complex (QRS < 0.12 seconds on ECG) or wide complex (QRS > 0.12 seconds on ECG).Interventions that may be attempted for emergency treatment of tachycardia include:

  • Vagal Maneuvers
  • Synchronized cardioversion
  • Medications
    • Adenosine
    • Amiodarone
    • Procainamide

Tachycardia Sequence

When the cardiac monitor indicates that the patient is in tachycardia follow the Tachycardia sequence:

  1. Throughout these steps, attempt to identify and treat the underlying cause.
  2. Monitor the heart rate and rhythm and blood pressure.
  3. Ensure oxygenation >94%.
  4. Determine if the tachycardia is stable or unstable. Unstable tachycardia will cause hypotension, altered level of consciousness, symptoms of shock or chest pain.
    1. If the patient has unstable tachycardia, perform immediate synchronized cardioversion:
      1. If the QRS is narrow and regular, cardiovert at 50-100 Joules.
      2. If the QRS is narrow and irregular, cardiovert at 120-200 Joules.
      3. If the QRS is wide and regular, cardiovert at 100 Joules.
      4. If the QRS is wide and irregular, turn off the synchronized mode and defibrillate.
    2. If the patient has stable tachycardia, continue to Step 5.
  5. Establish an IV or IO access for fluid and medication administration.
  6. Consider giving Adenosine 6 mg bolus; may give a second dose of 12 mg if needed.
  7. If Adenosine is not effective, consider giving Procainamide 20-50 mg to a maximum dose of 17 mg/kg with a maintenance infusion of 1-4 mg/minutes OR Amiodarone 150 mg over 10 minutes with second dose for recurrent Ventricular Tachycardia followed by infusion of 1 mg/min.
  8. For QRS interval >0.12 seconds, consider adenosine if the QRS intervals are regular.
  9. Consider an antiarrhythmic infusion.
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