Adult Tachycardia

Question 1

What is concerning for tachy?

Answer 1

> 150

(brady = <50 + symptoms)

Question 2

What is the initial management of tachy?

Answer 2

ABCDEs and Identify and treat underlying cause

1. Maintain patent airway (assist breathing if necessary)
2. O2 if hypoxemic
3. Cardio monitor, monitor BP, and oximetry
4. IV access
5. 12 lead EKG

Question 3

After stabilizing the patient, but having persistent tachy, what do you do?

Answer 3

Evaluate for concerning s/s

hypotension
AMS
Shock
Chest pain
Acute HF (same s/s as brady!)

Question 4

If the patient DOES have concerning s/s, what is the next step?

Answer 4

1. Consider sedation
2. If regular narrow complex, consider adenosine
3. if refractory to treatment, consider anitrythmic drugs (explained later) and expert opinion

Question 5

If a patient does NOT have any concerning s/s, what is your next step?

Answer 5

Assess the QRS complex width

Question 6

If the QRS width is < 0.12 seconds, the patient has tachy, but there are no concerning s/s, what do you do?

Answer 6

1. Vagal maneuvers (if regular rhythm)
2. Adenosine (if regular)
3. BB or CCB
4. Consider expert consultation

Question 7

Adenosine dose

Answer 7

6 mg IV, NS, then 12 mg 2nd dose if needed

Question 8

If the QRS width is > 0.12 seconds, the patient has tachy, but there are no concerning s/s, what do you do?

Answer 8

1. Adenosine only if regular and monomorphic
2. antiarrythmic infusion (explained later)
3. expert consultations

Question 9

What are the antiarrythmic drugs used for tachy?

Answer 9

Sotalol IV
Amiodarone IV
Procainamide IV

SAP to slow down rhythm of heart

Question 10

Procainamide IV dose and max dose

Answer 10

20-50 mg/min

max of 17 mg/kg

Question 11

Amiodarone IV dose

Answer 11

150 mg over 10 min (repeat as needed if VT occurs)
1 mg/min for 6 hours

Ami has 150 IQ

Question 12

Sotalol IV dose

Answer 12

100 mg (1.5mg/kg over 5 min)