ACLS Tachycardia with a pulse algorithm

Question 1

What is the first step in this algorithm?

Answer 1

Airway, oxygen, cardiac monitor, vital signs

Question 2

What is the second step of this algorithm?

Answer 2

Assess for hypotension, AMS, shock, Ischemic chest pain, acute heart failure

Question 3

Patient is tachycardic with signs of AMS or shock, what is next?

Answer 3

Synchronized cardioversion

May consider adenosine if narrow complex and regular

Question 4

Who immediately gets cardioverted?

Answer 4

Any tachycardia with hypotension, ischemic chest pain, AMS, shock, acute heart failure

Question 5

What is the third step in this algorithm?

Answer 5

Assess if wide or narrow complex

Question 6

Pt has tachycardia and without immediate complications and is found to have a wide complex, what is next?

Answer 6

EKG
Consider adenosisne if regular and monomorphic
Consider antiarrhythmic infusion
Consult specialist

Question 7

What are the antiarrhythmic drugs used for wide complex and the initial doses?

Answer 7

Procainamide 20–50mg.min until resolution or hypotension or QRS duration increases more than 50% or max dose of 17mg/kg. Avoid in long QT or CHF

Amiodarone: 150mg over 10 minutes and repeat as needed

Sotalol: 1.5mg/kg over 5 minutes. Avoid in long QT

Question 8

What is the intervention if no immediate complications and found to have a narrow complex?

Answer 8

EKG
Vagal maneuvers
Adenosine (if regular)
Beta blocker or calcium channel blocker
Expert consultation

Question 9

What is the dosing of adenosine?

Answer 9

6mg fast IV push followed by NS push

12mg fast if needed for second dose

Question 10

What is the dosing for cardioversion?

Answer 10

For narrow or wide and regular: 100 J synchronized
For narrow and irregular: 120–200 J synchronized
Wide irregular: defibrillate