Algorithm for Tachycardia with Pulse - Flowchart
Algorithm for Tachycardia with Pulse - Flowchart Adult Resuscitation Adult Resuscitation
«Flowchart»

Tachycardia with pulse

Tachycardia with pulse

Tachycardia with pulse

Stable, no adverse features

Stable, no adverse features

Stable, no adverse features

Hypotension, shock
Altered mental status
Myocardial ischemia
Acute heart failure

Hypotension, shock
Altered mental status
Myocardial ischemia
Acute heart failure




Hypotension, shock

Evaluate QRS, rhythm

Evaluate QRS, rhythm

Evaluate QRS, rhythm

Narrow

Narrow

Narrow

Wide (>120 ms)

Wide (>120 ms)

Wide (>120 ms)

End

End

End

Adenosinea

Adenosinea

Adenosinea

a a

Regular, narrow

Regular, narrow

Regular, narrow

Synchronized cardioversion

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

    •

    Synchronized cardioversion

    Synchronized cardioversion

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J
    • Synchronized cardioversion

    Synchronized cardioversion

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

    •

    Synchronized cardioversion

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

    •

    Synchronized cardioversion

    Synchronized cardioversion

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

  • Narrow, regular: 50-100 J
  • Narrow, irregular: 120-200J
  • Wide, regular: 100J
  • Wide, irregular: defibrillation 200J

    • β-blocker, CCBc

    β-blocker, CCBc

    β-blocker, CCBc

    β c c

    Adenosine

    Adenosine

    Adenosine

    β-blocker, CCB

    β-blocker, CCB

    β-blocker, CCB

    β

    Amiodaroned

    Amiodaroned

    Amiodaroned

    d d

    Defibrillation if unstable

    Defibrillation if unstable

    Defibrillation if unstable

    Adenosine

    Adenosine

    Adenosine

    Regular

  • SVT with aberrancy
  • Monomorphic VT

    •

    Regular

  • SVT with aberrancy
  • Monomorphic VT

  • SVT with aberrancy
  • Monomorphic VT
    • Regular

    Irregular

  • Polymorphic VT

    •

    Irregular

  • Polymorphic VT

  • Polymorphic VT
    • Irregular

    Amiodaroned,e

    Amiodaroned,e

    Amiodaroned,e

    d, d, e e

    aAdenosine should not be prioritized over cardioversion with unstable patients. It is given as a 6-mg IV push with a potential second dose of 12 mg (avoid with history or evidence of WPW).

    aAdenosine should not be prioritized over cardioversion with unstable patients. It is given as a 6-mg IV push with a potential second dose of 12 mg (avoid with history or evidence of WPW).

    aAdenosine should not be prioritized over cardioversion with unstable patients. It is given as a 6-mg IV push with a potential second dose of 12 mg (avoid with history or evidence of WPW).

    a

    bConsider vagal stimulation before adenosine for stable, regular, narrow tachyarrhythmias.

    bConsider vagal stimulation before adenosine for stable, regular, narrow tachyarrhythmias.

    bConsider vagal stimulation before adenosine for stable, regular, narrow tachyarrhythmias.

    b

    cGenerally metoprolol, esmolol infusion, or diltiazem push.

    cGenerally metoprolol, esmolol infusion, or diltiazem push.

    cGenerally metoprolol, esmolol infusion, or diltiazem push.

    c

    dAmiodarone given as 150 mg IV over 10 minutes followed by an infusion of 1 mg/min.

    dAmiodarone given as 150 mg IV over 10 minutes followed by an infusion of 1 mg/min.

    dAmiodarone given as 150 mg IV over 10 minutes followed by an infusion of 1 mg/min.

    d

    eAlternatives to amiodarone for regular, wide complex include procainamide or sotalol.

    eAlternatives to amiodarone for regular, wide complex include procainamide or sotalol.

    eAlternatives to amiodarone for regular, wide complex include procainamide or sotalol.

    e

    Regularb

    Sinus
    A flutter
    AVRT/AVNRT
    Junctional

    Regularb

    b b

    Sinus
    A flutter
    AVRT/AVNRT
    Junctional




    Regular

    Irregular

    Atrial fibrillation
    Multifocal atrial tach
    Sinus + ectopy

    Irregular

    Atrial fibrillation
    Multifocal atrial tach
    Sinus + ectopy



    Irregular