Tachycardia resident survival guide

❑  12-lead ECG, don’t delay therapy
❑  IV/IO access
❑  Check Ventilation
❑  Supplementary oxygen if hypoxemic
❑  Check heart rate and blood pressure
❑  Check signs of end-organ hypoperfusion

❑  Altered mental status

❑  Cold extremities

❑  Cyanosis

❑  Oliguria (urine output <0.5 mL/kg/h)

❑  Sustained hypotension (≥30 min)

❑  SBP <90 mm Hg or

❑  MAP ↓ >30 mm Hg below baseline

❑  Ischemic chest discomfort

❑  Consider sedation

❑  Doses/details of synchronized cardioversion:

❑  Narrow regular: 50-100 Joule

❑  Narrow irregular: 120-200 Joule biphasic or 200 Joule monophasic

❑  Wide regular 100 Joule

❑  Wide irregular: defibrillation dose (Not synchronized)

❑  Adenosine IV dose:

❑  First dose: 6mg rapid IV push; follow with NS flush

❑  Second dose: 12mg if required

❑  Antiarrhythmic infusion for stable wide-QRS tachycardia:

❑  Procainamide IV Dose:

❑  20-50mg/min until:

❑  Arrhythmia suppressed

❑  Hypotension ensues

❑  QRS duration increases 50%

❑  Maximum dose 17mg/kg given.

❑  Maintenance infusion: 1-4 mg/min.

❑  Avoid if prolonged QT or CHF.

❑  Amiodarone IV Dose:

❑  First dose: 150mg over 10 minutes. Repeat as needed if VT recurs.

❑  Follow by maintenance infusion by 1mg/min for first 6 hours.

❑  Sotalol IV Dose:

❑  100mg (1.5mg/kg) over 5 minutes.

❑  Avoid if prolonged QT.