Adult Tachycardia with Pulse Algorithm

Question 1

HR indicating tachycardia…

Answer 1

150/min

Question 2

1st interventions for tachycardia

Answer 2

maintain airway

O2 PRN

cardiac monitor, BP, pulse-ox

Question 3

5 signs of symptomatic tachycardia

Answer 3

hypotension

AMS

signs of shock

angina

acute HF

Question 4

if symptomatic tachycardia, what is 1st line tx?

Answer 4

synchronized cardioversion

Question 5

when should you consider adenosine + synchronized cardioversion?

Answer 5

if regular, narrow complex symptomatic tachycardia

Question 6

cardioversion dose for narrow regular tachycardia…

Answer 6

50-100J

Question 7

cardioversion dose for narrow irregular tachycardia…

Answer 7

120-200J

Question 8

cardioversion dose for wide regular tachycardia…

Answer 8

100J

Question 9

cardioversion dose for wide irregular tachycardia

Answer 9

non-synchronized, defibrillation dose

Question 10

If persistent narrow QRS tachycardia… what is the initial management?

Answer 10

IV access + 12 lead ECG + Vagal Maneuvers

Question 11

A persistent, regular, narrow QRS tachyarrhythmia is refractory to vagal maneuvers. What drug should be given first?

Answer 11

Adenosine 6mg rapid IV push

Question 12

what is the dosage for the second dose of adenosine in regular narrow QRS tachyarrhythmia

Answer 12

12mg rapid IV push

Question 13

If regular, monomorphic wide complex tachyarrhythmia is present, what drug can be considered at what initial dose?

Answer 13

adenosine 6mg rapid IV push

Question 14

what 2 drug classes can be considered in narrow complex tachyarrhythmia if irregular or after adenosine…

Answer 14

beta blockers, CCBs

Question 15

3 anti-arrhythmics available for wide QRS tachyarrhythmias

Answer 15

procainamide
amiodarone
sotalol

Question 16

sotalol dose in tachyarrhythmia…

Answer 16

100mg over 5 minutes

Question 17

when should sotalol administration be avoided?

Answer 17

in presence of prolonged QT

Question 18

initial amiodarone IV dose for tachyarrhythmias…

Answer 18

150mg over 10 minutes repeated if VT recurs

Question 19

maintinence infusion of amiodarone following VT controlled with initial dose

Answer 19

1 mg/min for 6 hours

Question 20

initial procainamide IV dose for tachyarrhythmias

Answer 20

20-50 mg/min, max 17 mg/kg

Question 21

what 4 conditions necessitate ending procainamide infusion?

Answer 21

resolution of arrhythmia

hypotension

QRS duration increase of 50%

max dose given

Question 22

Under what 2 conditions should procainamide be avoided?

Answer 22

prolonged QT or CHF