Page 86 - Radiology Book

adult tacHycardia witH a Pulse
TACHYCARDIA with signs and symptoms related to the tachycardia
· Heart rate typically ≥ 150/minute if tachyarrhythmia present
· Rapid recognition of unstable state
· Rapid recognition of tachycardia-induced signs and symptoms
PRIMARY
EVALUATION
· Airway · Vitals
· Monitor · EKG
SIGNS OF INSTABILITY
· Altered mental status
· Ischemic chest pain
· Shock
· Hypotension
· Heart failure
NO YES
Synchronized Cardioversion
Synchronized Cardioversion
Standard sequence of energy levels
· Atrial utter and other SVTs often respond to lower energy levels (50–100 J).
· If initial shock fails, increase dose in a stepwise fashion (100, 200, 300, 360 J). · Premedicate if time and patient’s clinical
condition permits with conscious sedation or effective combination of analgesia and sedation.
· ·
Sedate if time permits
If regular narrow complex, consider adenosine
Wide QRS?
(>0.12 sec)
NO YES IV access, 12-lead EKG
Adenosine if regular and monomorphic Antiarrhythmic infusion Cardiology consultation
IV, EKG
Vagal maneuver Adenosine if regular ß-blocker or calcium channel blocker Cardiology consult
· ·
· ·
· · · ·
·
· Drug Therapy · Adenosine IV dose
· 1st dose: 6 mg rapid IV push
· 2nd dose: 12 mg if required
· Antiarrhythmic infusions for stable wide
complex tachycardia
· Amiodarone IV dose
· 1st dose: 150 mg over 10 minutes
· Repeat as needed if VT recurs
· Maintenance infusion 1 mg for
1st six hours
· Sotalol IV dose
· 100 mg (1.5 mg/kg) over 5 minutes
(avoid with prolonged QT or CHF)
· Procainamide IV dose
(avoid with prolonged QT or CHF)
· 20–50 mg/minute until arrhythmia
suppressed, hypotension, QRS duration increases to >50%, or max dose of 17 mg/kg is given
· Maintenance dose: 1–4 mg/minute
Consistent with and in respect to 2015 American Heart Association Guidelines. See latest algorithm at: https://eccguidelines.heart.org
· Narrow regular: 50–100 J
· Narrow irregular: biphasic, 100–120 J;
monophasic, 200 J
· Wide regular: 100 J
· Wide irregular: de brillation dose
(not synchronized)
· Unsynchronized shocks are delivered whenever the operator pushes the discharge control button (random shock).
· Synchronized shocks are delivered in synchrony with the QRS complex peak.
· Synchronization avoids shock delivery during the relative refractory portion of the cardiac cycle when a shock could produce VT/VF.
Southfield16
ACLS