Hi, I'm Mark from ACLS Certification Institute and welcome back to rapid algorithm review.
Now going to tachycardia rhythm, first you are looking for is the heart rate. Now remember, tachycardia is any rate over a hundred but in the ACLS algorithm we're looking for heart rates and pulses above 150. Next, why is this patient tachycardic. Try to find a cause for this tachycardia and begin supportive care. Maintain their airway. Do we need to provide them an airway, do we need to bag the patient? Supply oxygen to the patient if they're hypoxic. Check and maintain their blood pressure. Get a 12 lead EKG, start your supportive care.
Now, is tachycardia causing shock? Hypoperfusion? Altered Mental Status? Ischemic Chest Pain? If so, immediate synchronized cardioversion. Sedation would be okay as long as it doesn't hold up a immediate synchronized cardioversion. Remember, unstable patient- electricity, synchronized cardioversion.
Now synchronized cardioversion for a regular narrow complex tachycardia fifty to a hundred joules. If it's an irregular narrow complex tachycardia like an Afib or a rapid ventricular response, you gonna start your synchronized to a little higher. Maybe 120 to 200 joules.
Next, to asses is tachycardia wide or narrow. Again we're looking at the width of the QRS. If its greater than 0.12 seconds, you can call it as a wide complex tachycardia. If it's equal to or less than 0.12 seconds it's a narrow complex tachycardia. For narrow complex tachycardia, first drug up - Adenosine. Six milligrams, rapid IV push followed by a 20 cc syringe. We got to get that drug to the heart, we got to get there quickly because is only a few seconds and remember, Adenosine should only be used in regular rhythms not any irregular tachycardia. But regular tachycardias, Adenosine would be appropriate.
Now if Adenosine doesn't work consider a calcium channel blocker. You get an expert involved quickly. If this is a wide complex tachycardia, our first drug up, Amiodarone. Start an infusion of a 150 milligrams over 10 minutes. Remember stable tachycardias-drugs; unstable tachycardias- immediate synchronized cardioversion.
Okay, rapid-fire review. First, heart rate- over 150; next why are they tachycardic, try to figure that out; next ABCs- Airway- provide them an airway, oxygen, IV, monitor their oximetry, supportive care. Next, is the patient stable or unstable? If they are unstable and shocky, immediate synchronized cardioversion; doesn't matter if it's narrow or wide, immediate synchronized cardioversion. If they're stable, is the complex wide or narrow? Narrow complex, first drug up Adenosine, six milligrams rapid IV push. Wide complex, Amiodarone - a 150 milligrams over 10 minutes.
I'm Mark for ACLS Certification Institute. This is the rapid algorithm review for tachycardias. I'll see you in the next algorithm.