Tachycardia

Narrow complex tachycardia

Evaluation

• Obtain EKG and complete set of vital sign to check for hemodynamic instability
• If unstable follow ACLS protocol
  

Management

• Unstable: follow ACLS protocol and do not delay synchronized cardioversion 
• Try vagal maneuver or adenosine. 
• Vagal maneuver:
  • Valsalva
  • Carotid massage
• Adenosine: Warn patients that adenosis will make them feel terrible but it will be short. 
  • Dosing: 
    • Peripheral IV 6mg x1. may repeat one more time with the same dose several minutes later if not improving, then increase to 12mg dose x1
    • Central line: 3mg with a repeat dose and then increased dose to 6mg

  • DO NOT use in heart transplant recipient, wide complex tachycardia and WPW or previous allergy

Wide Complex Tachycardia

Evaluation

• Is patient stable or unstable
• If unstable or in doubt call code blue and follow ACLS protocol
• If stable obtain EKG, troponin, and electrolyte panel including magnesium
• Look for precipitating cause and medication list for QT prolonging agents

Management

• Replete electrolytes
• Discontinue QT prolonged agents. Magnesium sulfate 2g IV should be given if patient have prolonged Qtc (>450 in women and >470 in men)