Adult Tachycardia (with Pulse)

1 Identify SVT
(Heart rate >150)

2 Establish and Treat

Possible Causes
Secure patient airway, assist with respirations
as needed
Administer oxygen if hypoxic
Attach cardiac monitor, monitor BP and SPO2

3 Hypotension?
Shock?
No Ischemic Chest Pain? Yes Synchronized Cardioversion
AMS? Starting Doses:
Heart Failure? 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)
4 QRS Wide? 5 Immediate Synchronized
Yes Adenosine
(>
_ 0.12 sec) Cardioversion
6 mg rapid IV push,
If regular narrow complex,
follow with NS flush
consider Adenosine
2nd Dose: 12 mg

6 Establish vascular access

Antiarrhythmic Infusions
Run 12-Lead ECG if possible
Consider adenosine only if (Stable Wide-Complex)
No monomorphic and regular
Consider antiarrhythmic infusion Amiodarone:
Seek expert consult 150 mg over 10 min
Repeat as necessary if VT recurs

Procainamide:
20-50 mg/min until arrhythmia is
7 Establish vascular access suppressed, hypotension ensues,
Run 12-Lead ECG if possible QRS duration increases >50%, or
Consider vagal maneuvers maximum dose of 17 mg/kg is reached
Adenosine (if regular rhythm)
Administer -Blocker or
Calcium Channel Blocker
Sotalol:
100 mg (1.5 mg/kg) over 5 min
Seek expert consult