Sequence of Tachycardia

Refer the flowchart mentioned below to get a clear idea about the management of adult tachycardia.

Tachycardia is referred to a heart rate more than 100 beats per minute (BPM).It is faster than normal heart rate.

Generally, Tachycardia is classified as follows:

• Narrow complex- In narrow complex tachycardia, QRS is less than 0.12 seconds on ECG.
• Wide complex- On ECG reports, QRS is found to be more than 0.12 seconds in wide complex tachycardia.

The following measures can be used during the treatment of Emergency tachycardia:

• Synchronized cardioversion
• Vagal Maneuvers
• Drugs include:
  1. Amiodarone
  2. Adenosine
  3. Procainamide

Tachycardia Sequence:

As soon as tachycardia is found in patients during cardiac monitoring, the following tachycardia sequence should be followed:

1. Recognize and treat the underlying cause.
2. Examine the heart rate, rhythm and blood pressure.
3. Ensure oxygenation more than 94%.
4. Find out whether the tachycardia is stable or unstable. Altered level of consciousness, symptoms of shock or chest pain and hypotension may be found due to unstable tachycardia.

 Also read: ACLS Algorithm: Adult Cardiac Arrest

If unstable tachycardia is found in patients, then synchronized cardioversion should be performed without any delay.

• For narrow and regular QRS: cardiovert at 50-100 Joules.
• For narrow and irregular QRS: cardiovert at 120-200 Joules.
• For wide and regular QRS: cardiovert at 100 Joules.
• For wide and irregular QRS: turn off the synchronized mode and defibrillate.

If stable tachycardia is found in patients, then an IV or IO access for fluid and medication administration should be established.

• Establish an IV or IO access for fluid and medication administration.
• Adenosine should be given as 6 mg bolus form and if necessary, a second dose of 12 mg may be if given.
• If Adenosine is not found effective; in this case, Procainamide may be given at a dose of 20-50 mg with a maximum dose of 17 mg/kg and infusion of 1-4 mg/minutes is considered as maintenance dose or Amiodarone 150 mg over 10 minutes may be used with a second dose for recurrent Ventricular Tachycardia followed by infusion of 1 mg/min.
• Adenosine should be used for regular and QRS interval more than 0.12 seconds.
• An antiarrhythmic infusion should be considered.

Also read: ACLS Algorithm: Acute Coronary Syndrome

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