For SINUS tachycardia, search for and treat CAUSES of tachycardia.
If Pt unstable (CP, decreased BP, SOB, or AMS), call a code/notify physician STAT. Pt requires immediate intervention!
Immediate synchronized cardioversion:
Consider adenosine if REGULAR NARROW complex.
Sedate when clinical situation permits.
- Turn on defibrillator, attach ECG electrodes, press “synch” button, and verify that R waves are sensed by machine. If QRS complex is too wide for machine to identify R waves, switch to unsynchronized cardioversion.
- It may be necessary to adjust gain until each R wave has a synch marker.
- Select energy level based on arrhythmia below and attempt cardioversion.
| Rhythm | Waveform | Sequence |
|---|---|---|
Narrow—Regular (<0.12 sec) | Biphasic | 50–100 J (escalate as needed) |
| Monophasic | 50 J, 100 J, 200 J, 300 J, 360 J | |
Narrow—Irregular (<0.12 sec) | Biphasic | 120–200 J (escalate as needed) |
| Monophasic | 200 J, 300 J, 360 J | |
Wide—Regular ( | Biphasic | 100 J (escalate as needed) |
| Monophasic | 100 J, 200 J, 300 J, 360 J | |
Wide—Irregular ( | Biphasic | 120–200 J (defibrillation dose) |
| Monophasic | 360 J (defibrillation dose) |
0.12 sec)Monomorphic = all QRS are identical; polymorphic = QRS differ in shape.
- Assess rhythm, and refer to appropriate algorithm for treatment. Most defibrillators default back to nonsynchronized mode after each synchronized cardioversion. If subsequent synchronized cardioversion is needed, confirm that defibrillator is in synchronized mode.
- Consider torsade de pointes with all polymorphic VTs. If synchronization is delayed and clinical situation is critical, go immediately to unsynchronized cardioversion at 120 to 200 J biphasic or 360 J monophasic.