The following directs AHA accepted actions after tachycardia with symptoms due to the fast rate is discovered: Start the Secondary ABCDs with emphasis on oxygenation, IV, VS, and EKG, and consider the following questions:
| 1. Stable? |
Yes  next question |
No, unstable = Immediate electrical cardioversion |
| 2. Narrow? |
Yes next question |
No, wide = Consult an expert (QRS ≥0.12 sec) |
| 3. Regular? |
Yes see mnemonic
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No, irregular = Consult an expert |
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Yes 1-2-3, think SVT, then V-A-C |
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| Vagal maneuvers, if this fails.. | ||
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Adenosine 6mg rapid IV push (may repeat x2, q1-2min. at 12mg) |
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Cardizem
(diltiazem) managed by an expert if stable, narrow, regular tachyarrhythmia continues |
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Perform immediate electrical cardioversion if a patient becomes unstable at any time. For sinus tachycardia consider possible causes and treat accordingly.
Most stable tachycardia rhythms require management by an expert due to the challenge of accurately determining and safely treating tachyarrhythmias. A sampling of rhythms and possible expert interventions are listed below.
Atrial Fibrillation, Multifocal Atrial Tachycardia, possibly Atrial Flutter
Rate Control: diltiazem or beta blocker
Recurrent SVT, Atrial Flutter, Junctional or Ectopic Atrial Tachycardia
Rate Control: diltiazem or beta blocker
(Avoid calcium channel blockers and digoxin due to possible AF+WPW)
Consider amiodarone. Magnesium 2g IV over 5min. for torsades
If VT, amiodarone 150mg IV over 10min. repeat prn (max 2.2g IV/24hr),
elective synchronized cardioversion
