Treatment should not be based on HR alone! If Pt is otherwise asymptomatic (no CP or SOB, stable BP, etc.), implement supportive care measures, notify physician STAT, and search for reversible causes.

Narrow-Complex (<0.12 sec)

• Obtain IV access—12 lead if available.
• Vagal Maneuvers: Instruct Pt to cough/bear down.
• Adenosine: 6 mg rapid IV push—follow with 20 mL rapid NS flush and elevation of extremity—repeat 12 mg if needed using same rapid-push technique. Maintain Pt in a mild, reverse Trendelenburg.

Wide-Complex (0.12 sec)

• Obtain IV access—12 lead if available.
• Consider adenosine 6 mg rapid IV push if regular and monomorphic (may be aberrant SVT).
• Consider antiarrhythmic—only one—consult expert:
• Procainamide: 20 to 50 mg/min IV—stop for arrhythmia suppression, hypotension, QRS duration increase of >50%, or max dose of 17 mg/kg. Infusion maintenance: 1 to 4 mg/min. Avoid with prolonged QT and CHF.
• Amiodarone: 150 mg IV over 10 min—repeat as needed if VT recurs. Follow by infusion maintenance of 1 mg/min for first 6 hr.
• Sotalol: 100 mg (1.5 mg/kg) IV over 5 min—avoid if QT prolonged.