THE TACHYCARDIA

ALGORITHM
 General ACLS Algorithm:
Step-by-step when you think rhythm is abnormal

RHYTHM

PULSE

With Pulse Pulseless

B.P. ARREST

STABLE UNSTABLE
CPR
 Overview of Tachycardia ACLS Algorithm:
When you think the rhythm is fast!
RHYTHM

PULSE
With Pulse Pulseless

B.P. ARREST

STABLE UNSTABLE
DEFIBRILLATE

DRUGS ELECTRICAL THERAPY

(Cardiovert) CPR
 TACHYARRHYTHMIA
oA fast rhythm with a rate of > 100 bpm

oIf heart rate < 150 bpm, look for an underlying

cause (treating the underlying disorder may
correct the tachycardia; (e.g. anemia)

oIf heart rate > 150 bpm, consider treating the

tachyarrhythmia promptly to stabilize the patient
Sinus bradycardia • Sinus tachycardia  Asystole
 Pulseless VT
Sinus pause • Supraventricular
tachycardia  Ventricular
Escape rhythms: fibrillation
Junctional • Atrial fibrillation  Pulseless
rhythm electrical
• Atrial flutter activity
Idioventricular
rhythm • Multifocal atrial
tachycardia
Heart blocks
• Ventricular
tachycardia
 Narrow QRS Wide QRS

Regular rhythm Grossly Irregular

Rhythm
• Sinus
tachycardia

• Supraventricular
tachycardia

• Multifocal atrial
tachycardia
Atrial
fibrillation

Atrial flutter

Accessory
pathway
Ventricular

fibrillation

Ventricular

tachycardia

(Monomorphic)

Torsade

de Pointes
 Narrow QRS tachycardia
DO’s
Check hemodynamic stability
Check QRS duration
Check regularity
Double check H’s and T’s as
reversible causes
Treat the patient, not the monitor
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-
/hypokalemia, Hypoglycemia, Hypothermia.

Toxins, Tamponade(cardiac),Tension
pneumothorax, Thrombosis (coronary and pulmonary),
and Trauma.
 Narrow QRS tachycardia
DON’Ts
Don’t defibrillate unstable VT with pulse
Don’t defibrillate unstable SVT
Don’t defibrillate unstable AF

Don’t delay cardioversion if unstable

Don’t cardiovert AF immediately (especially if unsure
of duration)

 Wide QRS Tachycardia
DO’s
•Check hemodynamic stability
•Check QRS duration
•Check regularity
•Get a 12 lead ECG if stable
•Double check H’s and T’s as reversible causes
•Treat the patient, not the monitor
 Wide QRS Tachycardia
DON’Ts
Don’t take a long time to study the ECG. When in
doubt, treat as VT.
Don’t give adenosine, verapamil or digoxin for
prexcited rapid AF (AF+WPW)
Don’t defibrillate unstable VT with pulse
Don’t treat the monitor, treat the patient.
Tachycardia
Check BP
Unstable (Hypotensive, altered sensorium)  Cardiovert (PLS
SEDATE)
Stable  Medication
Narrow QRS: Supraventricular tachycardia (SVT)  “If
SVT, VAC then 1-2-3”
Vagal maneuver – Adenosine 6-12-12 – Calcium
channel blocker (Verapamil), then Cardiovert
Wide QRS: Ventricular tachycardia (VT)
Adenosine (diagnostic for regular monomorphic)
Amiodarone
 Recap
Asystole/ PEA/ VF/ Pulseless VT
 DO CPR / ACLS
Tachycardia with pulse
 ASSESS HEMODYNAMICS
Hemodynamically significant Tachycardias
 Cardioversion
Stable Tachycardias
 Maneuvers, Medications to slow down HR