RRAPID: Narrow Complex Tachycardia

Question 1

Definition of Narrow Complex Tachycardias?

Answer 1

ECG rate > 100 beats/min
QRS complex < 0.12s
Establish if rhythm is irregular (e.g AF), or regular (e.g. SVT, junctional tachycardia)

Question 2

Presentation?

Answer 2

Palpitations
Fatigue
Light headedness
Chest pain
Angina
Dyspnoea 
Syncope

Question 3

Response (Airway)?

Answer 3

Give oxygen 15L/min via reservoir mask

Question 4

Response (Breathing)?

Answer 4

Monitor O2 sats

Question 5

Response (Circulation)?

Answer 5

Monitor BP
IV access: fluids PRN
Bloods: FBC, U&Es, LFT, calcium, magnesium, glucose
Perform 12 lead ECG
Identify adverse features

Question 6

Adverse features? (4)

Answer 6

Shock (systolic BP < 90 mmHg)
Syncope
MI
HF

Question 7

Mx of NCT with adverse features?

Answer 7

Synchronised DC SHOCK (max 3 times)
Amiodarone 300 mg IV over 20-30 mins
SHOCK
Amiodarone 900 mg IV over 24 hrs

Question 8

Mx of Regular NCT without adverse features?

Answer 8

Treat for SVT:
Vasovagal manœuvres
Adenosine 6mg IV bolus (rapid)
–> 12mg

Question 9

What must you monitor extra closely when giving adenosine?

Answer 9

ECG

Question 10

Mx of Irregular NCT without adverse features?

Answer 10

Treat for AF:
Beta-blocker or digoxin for rate control
Amiodarone if evidence of HF