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Tachycardia

  • Assess using the ABCDE-approach
  • Give oxygen if appropriate and obtain IV-access
    • Monitor ECG, BP, SpO2, record 12-lead ECG
    • Identify and treat reversible causes (e.g electrolyte abnormalities)

    Adverse features?

    • Shock
    • Syncope
    • Myocardial is chaemia
    • Heart failure

    Synchronised DC Shock

    Up to 3 attempts

    QRS

    Is QRS narrow (< 0.12s)?

    Amiodarone

    • Amiodarone 300 mg IV over 10 - 20 min and repeat shock
    • Follow with Amiodarone 900 mg over 24 h

    Broad QRS

    Is rhythm regular?

    Narrow QRS

    Is rhythm regular?

    Irregular

    Seek expert help!
    Possibilities include:
    • AF with bundle branch block (treat as for narrow complex)
    • Pre-excited AF (consider amiodarone)
    • Polymorphic VT (e.g. torsade de pointes - give magnesium 2 g over 10 min)

    Regular

    If ventricular tachycardia (or uncertain rhythm):
    • Amiodarone 300 mg IV over 20-60min; then 900 mg over 24 h
    If previously confirmed SVT with bundle branch block:
    • Give adenosine as for regular narrow complex tachycardia

    Irregular

    Probable atrial fibrillation
    Control rate with:
    • β-blocker or diltiazem
    • Consider diogoxin or amiodarone if evidence of heart failure

    Regular

    • Use vagal manoeuvres
    • Adenosine 6 mg rapid IV bolus; if unsuccesful give 12 mg; if unsuccesful give 12 mg.
    • Monitor ECG continuously

    Sinus rhythm restored?

    Sinus rhythm restored

    Probable re-entry paroxysmal SVT:
    • Record 12-lead ECG in sinus rhythm
    • If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis

    Sinus rhythm not restored

    Seek expert help!
    Possible atrial flutter:
    • Control rate (e.g. β-blocker)
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    Robbert van Zuiden
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