UST Life Support Training Center

Tachyarrhythmia

Tachyarrhythmia algorithm

2010 recommendation

V - Verbalize; Vital signs

O – Oxygen (if SpO2 is < 945)

M – Monitor .

I – Intravenous fluid .

T – Treat (H and Ts) .

Stable Unstable

Vagal maneuver

If unresponsive

Adenosine 6mg/IV Synchronized Cardioversion

If unresponsive

Adenosine 12 mg/IV

If unresponsive

Adenosine 12 mg/IV

Important Issues:

Confronted with a patient, remember the nemonic VOMIT

V- Verbalize - meaning talk with the patient, ask what is wrong, check level of

Consciousness

-Vital signs - to determine whether the patient is stable or unstable

In ACLS, a systolic BP of less than 90 mmHg is considered unstable

O – Oxygen - Give supplemental oxygen only if SpO2 is < 94%

M- Monitor - Connect patient to monitor to identify the rhythm

I - Intravenous access (if not possible, intraosseous)

T- Treat the cause (H and Ts)

For Tachyarrhythmia

1. If stable, do vagal maneuver (carotid massage, valsalva maneuver, coughing, etc). For elderlies, carotid massage is not recommended (risks of thromboembolism)

a. If no response, then may proceed to pharmacologic intervention.b. Give adenosine 6mg/IV followed by 20 ml of saline flush and

elevation of hand.c. If no response with the initial dose of adenosine, may increase

dose to 12mg/IV followed by 20 ml of saline flush and elevation of hand

d. If no response to 2nd dose of adenosine, may go for another dose of adenosine 12mg/IV followed by 20 ml saline flush and elevation of hand.

2. If unstable, GO FOR synchronized cardioversion. DO NOT GO FOR pharmacologic intervention. Remember: Drugs that lower heart rate is likely to lower BP.

a. For narrow complex tachycardia (SVT), use 50 to 100 joulesb. For wide complex tachycardia like (V Tach) use 100 to 200 joules

*if the qrs is narrow (small), use smaller dose if the qrs is wide (bigger), use bigger dose

c. For atrial fibrillation, use 120j.