Tachy with a Pulse

Question 1

Clinical picture + HR over …

Answer 1

150bpm

Question 2

tachy and unstable? (CP, hypotension, AMS, shock, HF)

Answer 2

Synchronized cardioversion OR

adenosine (if narrow and regular)

Question 3

Joules if QRS is: narrow/regular

Answer 3

50-100J

Question 4

Joules if QRS is: narrow/irregular

Answer 4

120-200J biphasic or 200J monophasic

Question 5

Joules if QRS is wide/regular

Answer 5

100J

Question 6

Joules if QRS is wide/irregular

Answer 6

Defibrillation (UNSYNCHRONIZED: 120-200J biphasic or 360J monophasic)

Question 7

Tachy and stable –> worry about

Answer 7

Is the QRS wide?

Question 8

Tachy, stable, wide QRS

Answer 8

IV, EKG
adenosine (if regular/monomorphic)
antiarrhythmic infusion
consult expert

Question 9

Tachy, stable, wide QRS… how much adenosine?

Answer 9

6mg rapid push (1st dose) –> 12mg rapid push (2nd dose)

Question 10

Antiarrhythmic infusions for tachy, stable, wide QRS

Answer 10

Procainamide: 20-50 mg/min until better or becomes unstable (avoid if long QT or CHF)
Amiodarone: 150mg over 10 min –> 1mg/min for next 6 hrs
Sotalol: 100 mg over 5 min (avoid if long QT)

Question 11

Tachy, stable, narrow QRS …

Answer 11

IV, EKG
Vagal maneuvers
Adenosine (if reg)
BB or CCB
Consult cardio