Adult Tachycardia - Wide Complex

Question 1

WCT with serious signs or symptoms:

Answer 1

dyspnea, chest pain, syncope/near-syncope,
hemodynamic compromise, altered mental status
or other signs of end organ hypoperfusion

Question 2

SBP<90 with normal perfusion and LOC

Answer 2

B
Administer O2, Vital sign assessment, including
temperature if available
P 
IV/IO access, O2, Cardiac monitor

Question 3

Is the wide tachy regular?

Answer 3

Administer amiodarone (first line) 150 mg IV/IO in D5W/NS,

infuse over 10 minutes
May repeat x 1 if no response

Consider adenosine in patients with history of SVT with
abberancy and/or prior conversion with adenosine -
administer 6 mg adenosine IV/IO, followed by 10 mL aline

flush
May repeat x 1 at 12 mg

Question 4

Tachy is irregular?

Answer 4

Administer amiodarone 150 mg IV/IO
D5W/NS, infuse over 10 minutes
May repeat x 1 if no response

Question 5

After either regular or irregular tachy has been given drugs…

Answer 5

Administer amiodarone 150 mg IV/IO
D5W/NS, infuse over 10 minutes
May repeat x 1 if no response

Question 6

SBP<90 and poor perfusion and ALOC

Answer 6

Cardioversion:
120 Joules
(Attempt to synchronize, if no sync and unstable -
defibrillate)
May repeat if needed, check pulse and evaluate for cardiac
arrest if no conversion)

Question 7

Pharmacology for post cardioversion

Answer 7

For torsades, administer Magnesium 2 g IV/IO over 1-2
minutes
Consider Sedation Prior to Cardioversion:
- Midazolam 2.5 mg IV/IO or 5 mg IM
- May repeat as needed; Max 10 mg
Administer 500 mL NS/LR fluid bolus

Question 8

If all else fails

Answer 8

Cardiac arrest AGs