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ACLS Algorithms (aclsalg.htm) / ACLS Tachycardia Algorithm for Managing Unstable Tachycardia
Version control: This document is current with respect to 2015 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are
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If the patient is seriously ill or has cardiovascular disease, the patient may have symptoms at lower rates.
Print PDF (images/algo-tachycardia.pdf)
If the patient's heart rate is above 150 bpm and the patient is unstable (has symptoms), cardioversion is often
required.
Sinus tachycardia is always a compensatory response to an underlying condition that creates a need for
increased cardiac output. Sinus tachycardia does not respond to cardioversion, and a shock may actually Order the full set of
increase the patient's heart rate. The treatment for sinus tachycardia is aimed at fixing the underlying cause, printed crash cart cards
such as relieving pain, replacing volume, or relieving anxiety.
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Overview
The ACLS Tachycardia Algorithm is organized around the following questions:
Steps
Does the patient have a pulse? If no, the patient’s rhythm is PEA and should be treated as such.
If yes:
Look for altered mental status, ongoing chest pain, hypotension, or other signs of shock.
Remember: Rate-related symptoms are uncommon if heart rate is less than 150 bpm.
If the signs and symptoms continue after you have given oxygen and supported the airway and circulation AND if significant symptoms are due to the tachycardia, then the
tachycardia is UNSTABLE and immediate cardioversion is indicated.
If you determine that the patient has an unstable tachycardia, perform immediate synchronized cardioversion. This is not a decision to take lightly as it carries with it a
significant risk of stroke.
1. Start an IV.
2. Give sedation if the patient is conscious.
3. Do not delay cardioversion.
4. Consider expert consultation.
If you determine that the patient has a stable tachycardia, start an IV and obtain a 12-lead ECG
For a patient with a stable tachycardia, decide if the QRS complex is wide or narrow and if the rhythm is regular.
Does the patient's rhythm convert? If it does, the rhythm was atrial in origin. The conversion of a rhythm by adenosine is considered diagnostic of atrial arrhythmia. At this
point you watch for a recurrence. If the tachycardia resumes, treat with adenosine or longer-acting AV nodal blocking agents such as diltiazem or beta-blockers.
Irregular rhythm Control patient's rate with diltiazem or beta-blockers. Use beta-blockers with caution for patients with pulmonary disease or congestive
heart failure.
If the rhythm is irregular narrow-complex tachycardia, it is probably atrial fibrillation, possible atrial flutter, or multi-focal atrial tachycardia.
If patient is in ventricular Amiodarone 150 mg IV over 10 min; repeat as needed to maximum dose of 2.2 g in 24 hours. Prepare for elective synchronized cardioversion.
tachycardia or uncertain The half life of amiodarone is very long. If possible consult a cardiologist before using in a stable patient. Another choice would be to use
rhythm procainamide.
If patient is in SVT with Adenosine 6 mg rapid IV push If no conversion, give 12 mg rapid IV push; may repeat 12 mg dose once
aberrancy
If pre-excited atrial fibrillation (AF + WPW) Avoid AV nodal blocking agents such as adenosine, digoxin, diltiazem, verapamil.
Consider amiodarone 150 mg IV over 10 min
You may not always be able to tell from the ECG whether the rhythm is ventricular or supraventricular. Most wide-complex tachycardias originate in the ventricles (particularly
if the patient is older or has underlying heart disease). If the patient does not have a pulse, treat the rhythm as ventricular fibrillation and follow the Pulseless Arrest Algorithm.
If the patient is unstable and has a wide-complex tachycardia, assume the rhythm is VT until you can prove otherwise.
(https://www.acls.net/judy-bio.html) Written by Judy Haluka (https://www.acls.net/judy-bio.html) and last updated Apr 1, 2017
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