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ACLS Tachycardia Algorithm for Managing Stable Tachycardia

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Algoritmo para el manejo de taquicardias
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  Is the rhythm regular or irregular?Is the rhythm sinus tachycardia? Guidelines SituationAssessment and Actions Patient has significant signs or symptomsof tachycardia AND they are beingcaused by the arrhythmia.The tachycardia is unstable. Immediatecardioversion is indicated.Patient has a pulseless ventriculartachycardia.Follow the Pulseless Arrest Algorithm.Deliver unsynchronized high-energyshocks.Patient has polymorphic ventriculartachycardia AND the patient is unstable.Treat the rhythm as ventricular fibrillation.Deliver unsynchronized high-energyshocks. Steps for Managing Stable TachycardiaDoes the patient have a pulse? Yes, the patient has a pulse.  Complete the following:Assess the patient using the primary and secondary surveys.1.Check the airway, breathing, and circulation2.Give oxygen and monitor oxygen saturation.3.Get an ECG.4.Identify rhythm.5.Check blood pressure.6.Identify and treat reversible causes.7. Is the patient stable? Look for altered mental status, ongoing chest pain, hypotension, or other signs of shock. Remember: Rate-related symptoms are uncommon if heart rate is < 150 bpm. Yes, the patient is stable. Take the following actions:Start an IV.1.Obtain a 12-lead ECG or rhythm strip.2. Is the QRS complex wide or narrow? PatientTreatment  ✁✂✄☎✆✝✞✟✝✆✠✡☛✆☞✌✍✠☛✎✞✏✑✍✠✒✆✓✆✌☛✓✌✄✎✆✔☞✕✖✖✖✞✎✎✗✘✙✚✚✛✛✛✖✆✝☞✘✖✓✕✎✚✆✝☞✘✜✎✆✝✞✟✝✆✠✡☛✆✜✆☞✌✍✠☛✎✞✏✜✘✖✖✖ ✢  ✡✕  ✣✤✥  ✚ ✦✥  ✚✤✣✦✧  ✙ ✦★   The patient's QRS is narrow and rhythmis regular.Try vagal maneuvers. Give adenosine 6mg rapid IV push. If patient does notconvert, give adenosine 12 mg rapid IVpush. May repeat 12 mg dose ofadenosine once.Does the patient's rhythm convert? If it does, it was probably reentry supraventricular tachycardia. At this point youwatch for a recurrence. If the tachycardia resumes, treat with adenosine or longer-acting AV nodal blocking agents,such as diltiazem or beta-blockers. PatientTreatment The patient's QRS is narrow (< 0.12 sec).Consider an expert consultation.The patient's rhythm is irregular.Control patient's rate with diltiazem orbeta-blockers. Use beta-blockers withcaution for patients with pulmonarydisease or congestive heart failure.If the rhythm pattern is irregular narrow-complex tachycardia, it is probably atrial fibrillation, possible atrial flutter, ormulti-focal atrial tachycardia. PatientTreatment Patient's rhythm has wide (> 0.12 sec)QRS complex AND Patient's rhythm isregular.Expert consultation is advised.Patient is in ventricular tachycardia oruncertain rhythm.CAmiodarone 150 mg IV over 10 min;repeat as needed to maximum dose of2.2 g in 24 hours. Prepare for electivesynchronized cardioversion.Patient is in supraventricular tachycardiawith aberrancy.Adenosine 6 mg rapid IV push If noconversion, give adenosine 12 mg rapidIV push; may repeat 12 mg dose once.Patient's rhythm has wide (> 0.12) QRScomplex AND Patient's rhythm isirregular.Seek expert consultation.If pre-excited atrial fibrillation (AF +WPW)Avoid AV nodal blocking agents such asadenosine, digoxin, diltiazem, verapamil.Consider amiodarone 150 mg IV over 10min.Patient has recurrent polymorphic VTSeek expert consultation,  ✁✂✄☎✆✝✞✟✝✆✠✡☛✆☞✌✍✠☛✎✞✏✑✍✠✒✆✓✆✌☛✓✌✄✎✆✔☞✕✖✖✖✞✎✎✗✘✙✚✚✛✛✛✖✆✝☞✘✖✓✕✎✚✆✝☞✘✜✎✆✝✞✟✝✆✠✡☛✆✜✆☞✌✍✠☛✎✞✏✜✘✖✖✖ ✢  ✡✕  ✣✤✥  ✚ ✦✥  ✚✤✣✦✧  ✙ ✦✢   If patient has torsades de pointes rhythmon ECGGive magnesium (load with 1-2 g over5-60 min; then infuse. Caution:  If the tachycardia has a wide-complex QRS and is stable, consult with an expert. Management andtreatment for a stable tachycardia with a wide QRS complex and either a regular or irregular rhythm should be donein the hospital setting with expert consultation available. Management requires advanced knowledge of ECG andrhythm interpretation and anti-arrhythmic therapy. Considerations: You may not be able to distinguish between a supraventricular wide-complex rhythm and a ventricularwide-complex rhythm. Most wide-complex tachycardias srcinate in the ventricles.If the patient becomes unstable, proceed immediately to treatment. Do not delay while you try to analyze therhythm.If the patient becomes unstable, proceed immediately to treatment. Do not delay while you try to analyze therhythm. © 2013 ACLS Training Center | Privacy (/privacy.htm) | Terms (/terms.htm)  ✁✂✄☎✆✝✞✟✝✆✠✡☛✆☞✌✍✠☛✎✞✏✑✍✠✒✆✓✆✌☛✓✌✄✎✆✔☞✕✖✖✖✞✎✎✗✘✙✚✚✛✛✛✖✆✝☞✘✖✓✕✎✚✆✝☞✘✜✎✆✝✞✟✝✆✠✡☛✆✜✆☞✌✍✠☛✎✞✏✜✘✖✖✖ ✢  ✡✕  ✢✣✤  ✚ ✥✤  ✚✣✢✥✦  ✙ ✥✧ 
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