ACLS Tachycardia with a pulse algorithm Flashcards
What is the first step in this algorithm?
Airway, oxygen, cardiac monitor, vital signs
What is the second step of this algorithm?
Assess for hypotension, AMS, shock, Ischemic chest pain, acute heart failure
Patient is tachycardic with signs of AMS or shock, what is next?
Synchronized cardioversion
May consider adenosine if narrow complex and regular
Who immediately gets cardioverted?
Any tachycardia with hypotension, ischemic chest pain, AMS, shock, acute heart failure
What is the third step in this algorithm?
Assess if wide or narrow complex
Pt has tachycardia and without immediate complications and is found to have a wide complex, what is next?
EKG
Consider adenosisne if regular and monomorphic
Consider antiarrhythmic infusion
Consult specialist
What are the antiarrhythmic drugs used for wide complex and the initial doses?
Procainamide 20–50mg.min until resolution or hypotension or QRS duration increases more than 50% or max dose of 17mg/kg. Avoid in long QT or CHF
Amiodarone: 150mg over 10 minutes and repeat as needed
Sotalol: 1.5mg/kg over 5 minutes. Avoid in long QT
What is the intervention if no immediate complications and found to have a narrow complex?
EKG Vagal maneuvers Adenosine (if regular) Beta blocker or calcium channel blocker Expert consultation
What is the dosing of adenosine?
6mg fast IV push followed by NS push
12mg fast if needed for second dose
What is the dosing for cardioversion?
For narrow or wide and regular: 100 J synchronized
For narrow and irregular: 120–200 J synchronized
Wide irregular: defibrillate