Resus - Tachycardia (adult) 2015

Question 1

Step 1

Answer 1

ABCDE

• SpO2 and give oxygen
• 12-lead ECG
• BP
• IV access
• Treat reversible causes

Question 2

Step 2 (after ABCDE)

Answer 2

Adverse features

• Shock
• Syncope
• Myocardial ischaemia
• Heart failure

Question 3

If adverse features

Answer 3

• Synchronised DC shock (max 3 attempts)
• Seek expert help
• Amiodarone 300mg IV over 10-20 mins
• Repeat shock
• Amiodarone 900mg IV over 24h

Question 4

No adverse features

Answer 4

Is QRS narrow (under 0.12s)?

Question 5

Irregular broad QRS

Answer 5

• Seek expert help

Possibilities include

• AF + BBB (treat per narrow complex)
• Pre-excited AF (consider amiodarone)

Question 6

Regular broad QRS

Answer 6

If VT or uncertain rhythm
- Amiodarone 300mg IV over 20-60min then 900mg IV over 24h

If known SVT + BBB
- Treat per regular narrow-complex tachycardia

Question 7

Irregular narrow QRS

Answer 7

Probable AF

• Control rate with beta-blocker or diltiazem
• If in heart failure, consider digoxin or amiodarone
• Assess thromboembolic risk and consider anticoagulation

Question 9

Regular narrow QRS

Answer 9

• Vagal manoeuvres
• Adenosine 6mg rapid IV bolus
• If no effect, adenosine 12mg IV
• If still no effect, adenosine 12mg IV

Sinus rhythm achieved?

Yes

• Probable re-entry paroxysmal SVT
• Record 12-lead ECG in sinus rhythm
• If SVT recurs, treat again and consider anti-arrhythmic prophylaxis

No

• Seek expert help
• Possible atrial flutter e.g. with beta-blocker