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
When the cardiac monitor indicates that the patient is in tachycardia follow the Tachycardia sequence:
- Throughout these steps, attempt to identify and treat the underlying cause.
- Monitor the heart rate and rhythm and blood pressure.
- Ensure oxygenation >94%.
- Determine if the tachycardia is stable or unstable. Unstable tachycardia will cause hypotension, altered level of consciousness, symptoms of shock or chest pain.
- If the patient has unstable tachycardia, perform immediate synchronized cardioversion:
- If the QRS is narrow and regular, cardiovert at 50-100 Joules.
- If the QRS is narrow and irregular, cardiovert at 120-200 Joules.
- If the QRS is wide and regular, cardiovert at 100 Joules.
- If the QRS is wide and irregular, turn off the synchronized mode and defibrillate.
- If the patient has stable tachycardia, continue to Step 5.
- Establish an IV or IO access for fluid and medication administration.
- Consider giving Adenosine 6 mg bolus; may give a second dose of 12 mg if needed.
- 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.
- For QRS interval >0.12 seconds, consider adenosine if the QRS intervals are regular.
- Consider an antiarrhythmic infusion.