Resuscitation
www. ere. e info@erc.edu
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Tachycardia Algorithm (withpuise)
Support ABCs: give oxygen; cannulate a vein
Monitor ECG, BR Sp02
Record 12-lead ECG if possible; if not, record rhythm strip
Identify and treat reversible causes (e.g. electrolyte abnormalities)
Synchronised DC shock Up to 3 attempts
.Unstable
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Is patient stable?
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Amiodarone 300 mg IV over 10-20 min and repeat shock; followed by: Amiodarone 900 mg over 24 h
Signs of instability INCLUDE: 1. Reduced conscious level 3. Systolic BP < 90mmHg
2. Chest pain 4. Heart failure
(Rate-related symptoms uncommon at less than 150 beats min-1)
Broad QRS Is QRS regular?
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Broad
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y
Stable
Is QRS narrow (< 0.12 sec)?
Narrow
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>
Irregular
Regular
Regular
Seek expert help
:*:
Possibilities include:
AF with bundle branch block
treat as for narrow complex
Pre-excited AF
consider Amiodarone
Polymorphic VT (e.g. torsade de pointes)
give magnesium 2 g over 10 min
*
If Ventricular Tachycardia
(or uncertain rhythm):
•     Amiodarone 300 mg IV over 20-60 min; then 900 mg over 24 h
If previously confirmed SVT with bundle branch block:
•      Give adenosine as for regular narrow complex tachycardia
*
Use vagal manoeuvres Adenosine 6 mg rapid IV bolus; if unsuccesful give 12 mg; if unsuccesful give further 12 mg; Monitor ECG continuously
Normal sinus rhythm restored?
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Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia
Published March 2007 by European Resuscitation Council Secretariat VZW, Drie Eikenstraat 661, 2650 Antwerp, Belgium Product reference: POSTER-2007-ALSTA_A0-EN   Copyright European Resuscitation Council
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Probable re-entry PSVT:
• Record 12-lead ECG in sinus rhythm
• If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis
Narrow QRS Is QRS regular?
Irreaular
St
Irregular Narrow Complex Tachycardia Probable atrial fibrillation
Control rate with: ß- Blocker IV or digoxin IV If onset < 48 h consider Amiodarone 300 mg IV 20-60 min; then 900 mg over 24 h
No
........................> A
Seek expert help
Probable atrial flutter
• Control rate (e.g. ß-Blocker)
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