| Adult Resus:Acute Anaphylaxis
| Adult Resus:Basic Life Support
| Adult Resus: Advanced Life Support
|Adult Resus: Obstetric Cardiac Arrest
|Newborn/Child Resus: All
|Hypovolaemic or Haemorrhagic Shock
|Septic Shock and Sepsis
|Shock (General Assessment)
|Toxic Shock Syndrome
|Resus:Post Resuscitation Algorithm
|Resus:Acute Severe Asthma
The difficulty may be determining if tachycardia is the cause of the issue needing treatment or a caused by the issue or drugs e.g. salbutamol. Most sinus tachycardias not usually over 140/min in resting patient. Treat the cause e.g. Pneumonia, LVF and review. Context helps.
|Initial Tachycardia Management Summary|
- Any current syncope, shock, angina, heart failure/dyspnoea suggest UNSTABLE
- ABC, Oxygen, IV access, Treat LVF (Furosemide/GTN) or COPD
- Unstable: Sedation and 3 x Synchronised DC shocks + Amiodarone 300 mg IV over 20 mins
- Stable regular narrow: Adenosine 6 mg 12 mg. Verapamil 5 mg.
- Stable regular broad: Amiodarone 300 mg IV over 30 mins
- Stable irregular AF: IV Digoxin or Amiodarone 300 mg IV over 30 mins
- Sinus tachycardia may be seen due to underlying disease. The max heart rate is 220-age for men and 210 - age for women
- Arrhythmia + Following are signs of Unstable patient: syncope, shock, angina, heart failure/dyspnoea suggest instability needing urgent action
- Narrow complex tachycardias rarely cause collapse and usually benign and patient can usually be discharged when treated
- Wide complex tachycardias may cause collapse and may be due to VT and patients will need admitted and cardiology consult
- Get a 12-lead ECG of the arrhythmia which will be essential to distinguish VT from SVT and can help determine form of SVT or VT.
- Assume however that a broad complex tachycardia is VT unless you have incontrovertible evidence to the contrary. DC cardioversion treats both.
- FBC,U&E, Troponin, Lipids, Glucose 12-lead ECG
- Uncertain of the diagnosis of a broad complex tachycardia?
- Stable (Narrow Complex SVT): IV Adenosine (6-12 mg) fast injection + Vagal manoeuvres or Verapamil 5-10 mg slow IV (Avoid if broad complex)
- Stable (AF): IV Digoxin or Amiodarone 300 mg in 60 min followed by 900 mg/24 h until sinus rhythm restored (into central venous catheter)
- Unstable (VT/AF/ SVT): DC cardioversion with sedation. Amiodarone, 300 mg in 30-60 min followed by 900 mg/24 h until sinus rhythm restored (into central venous catheter). Fist dose may be given into large vein. Sotalol, 2 mg/kg IV over 30 min
- Unstable (VT) Broad complex. Lidocaine (lignocaine) 100 mg as IV bolus
over a few min followed immediately by IV magnesium (See below) infusion of 1-4 mg/min Magnesium sulphate, 8 mmol over 10-15 min
- Unstable (Torsade) Broad complex. Magnesium sulphate, 8 mmol over 10-15 min. Overdrive pacing