Tachycardia

Question 1

How do you initially assess a patient with tachycardia?

Answer 1

ABCDE approach, paying particular attention to:

• Airway and Breathing: RR and sats; give supplemental oxygen if sats < 94
• Circulation: HR, BP, obtain ECG and IV access

Question 2

In your initial A-E assessment, which ‘life-threatening’ features are you looking for?

If any of these are present, how do you proceed?

Answer 2

HISS:

• Heart failure
• Ischaemia
• Shock
• Syncope

If these are present, proceed to synchronised DC shock (up to 3 attempts)

Question 3

How can the causes of tachycardia be classified?

Answer 3

• Narrow complex

- Broad complex

Question 4

How can the causes of narrow complex tachycardia be classified?

Answer 4

• Regular (most likely SVT)

- Irregular (most likely AF)

Question 5

What is the initial management of AF with rapid ventricular response?

Answer 5

Rate control with beta blocker

Question 6

What are the initial management steps in managing a patient with SVT?

Answer 6

1. Vagal manoeuvres, e.g. carotid sinus massage, Valsalva manoeuvre
2. Adenosine IV 6mg bolus (if unsuccessful give 12mg; if unsuccessful again give 18mg)

Question 7

How can the causes of broad complex tachycardia be classified?

Answer 7

• Regular (likely VT)

- Irregular (likely polymorphic VT, AKA Torsades de pointes)

Question 8

Describe the initial management of regular broad complex tachycardia (likely VT) if there is no evidence of life threatening features?

Answer 8

Amiodarone 300mg IV over 10-60 mins

Question 9

Describe the initial management of irregular broad complex tachycardia (likely polymorphic VT) if there is no evidence of life threatening features?

Answer 9

Magnesium 2g over 10 mins