Adult Narrow Complex Tachycardia

Question 1

Stable patient irregular rhythm (A-fib, A-flutter)

Answer 1

Adenosine: 6mg IV/IO rapid push
12mg IV/IO rapid push x2
Diltiazem: 20mg IV/IO in 5 minutes
10mg IV/IO in 5 minutes >60 years old

Question 2

Unstable patient narrow regular rhythm.

Answer 2

Consider Sedation-Versed: 2-2.5mg IV/IO, max of 5mg

Sync Cardoversion: 50-100 joules

Question 3

Unstable patient narrow irregular rhythm.

Answer 3

Consider sedation-Versed: 2-2.5mg IV/IO, max of 5mg

Sync Cardioversion: 120-200 joules

Question 4

Stable patient regular rhythm.

Answer 4

Attempt vagal maneuvers.
Adenosine 6mg IV/IO rapid push, repeat 12mg x 2
Diltiazem 20mg IV/IO (>60 10mg IV/IO) Infusion 5mg/hr & 10mg/hr
if no conversion in 15 minutes attempt 25mg or 15mg