Aritmia

Takikardi
Bradikardi
Algoritma Takikardi
AVNRT : atrioventricular non re-entry tachycardia
AVRT : atrioventricular re-entry tachycardia Tachycardia with pulse
AF : atrial fibrilation Cardioversi sync
AFL : atrial flutter
ATAC : atrial tachycardia
(rarely needed for HR 150
NPJT : non paroxysmal junctional tachycardia Unstable or
MAT : multivocal atrial tachycardia
VT : ventricular tachycardia
Defibrilation for PMVT
Unstable = hypotension, shock
WCT : wide complex tachycardia Chest pain, heart failure
WPW : wolf Parkinson white
PMVT : polymorphic ventricular tachycardia
Stable
IV access, O2, Monitor BP & rhythm, 12 lead ECG

Narrow complex QRS (<120 msec) Wide complex QRS (120 msec)

Regular Irregular Regular Irregular

Vagal maneuvers AF, AFL or MAT VT or WCT AF w/ abberancy

Control rate w/ diltiazem Try adenosine Control rate w/ diltiazem or metoprolol
Adenosine Or metoprolol
No respone then : AF + WPW
Converts Does not Procainamide or Amio, proc or ibutilide
converts Amiodarone or
Sotalol or PMVT (normal QT)
Likely AVNRT or AVRT
Lidocaine Treat ischemia, amio or lidocaine & prepare
Recurrence Adenosine
For defibrillation
& prepare for sync cardioversion
Or Possibly AFL, ATAC, NPJT
long acting AV nodal Control rate w/ diltiazem or
Torsades ( QT)
Agents (diltiazem or Metoprolol
Correct electrolyte & other precip
metoprolol
Mg 2 g IV
Overdrive pacing or isopreterenol
 Cardioversion
Medication
Ancillary equipment
Adenosine 6mg rapid IVP then 20 ml NS bolus, 12 mg IVP
O2 saturation monitor, suction, IV line, q2min x 2 if needed
intubation equipment
Amiodarone 150 mg IV over 10 min
Diltiazem 15 20 mg IV over 2 min, 20 25 mg 15 min
Premedicate later prn, 5 15 mg/h
Call anesthesia service Ibutilide 1 mg over 10 min, repeat 1x if needed
Midazolam 1 5mg Lidocaine 1.0 1.5 mg/kg IVP, repeat in 5 10 min
Fentanyl 100 300mcg Metoprolol 5 mg IV repeat 3 time in 5 min
Procainamide 17 mg/kgBB at 50 mg/min (if avoid this EF
Synch cardioversion down)
Sotalol 100 mg IV over 5 min
50 200 J biphasic
Verapamil 2.5 5 mg IV over 2 min, 5 10mg 15 30 min
100 200 J monophasic
later prn
EKG TAKIKARDI
Ectopic-atrial-tachycardia-inverted-p-
waves
Atrial Fibrilasi
Atrial Flutter
Multifocal atrial tachycardia
Ventricular Tachycardia
Ventricular Tachycardia
Polymorphic
Ventricular Fibrilation
Torsades de Pointes
Algoritma Bradikardi
 Bradycardia with pulse

Airway, IV access, O2, Monitor BP & rhythm, 12 lead ECG

Hypotension, shock, chest pain, Unstable No Observe

Heart failure

Yes
AVB Type II / Type III,
Proceed to pacing ASAP Atropine 0.5 mg IV 3 5 min, max 3 mg

Transvenous pacing or
Dopamine 2 10 mcg/kg/min, or
Epinephrine 2 10 mcg/min, or
Isoproterenol 2 10 mcg/min

Transvenous pacing
AV Block