Tachycardia

Question 1

What is the first treatment for unstable tachycardia?

Answer 1

-Immediate cardioversion
-Consider sedative drugs in conscious pts but do not delay cardioversion

Question 2

What is the key approach to managing a pt w/ tachycardia?

Answer 2

-Does pt have a pulse?
-If pulses are present determine whether the pt is stable or unstable then provide treatment based on the pt’s condition & rhythm

Question 3

How is narrow complex sinus tachycardia treated?

Answer 3

-Adenosine
-Search for the cause & treat the cause
-Cardioversion is not indicated for sinus tachycardia

Question 4

What is the significance of a HR >150?

Answer 4

-ST w/ HR >150 is most likely cause by an arrhythmia
-For Sx of instability when the HR is <150 is is unlikely that the cause is tachycardia unless the pt has impaired ventricular function

Question 5

When is Tachycardia considered unstable?

Answer 5

-When the heart rate is too fast for the patient’s clinical condition

Question 6

How can an excessive heart rate cause the patient to be unstable?

Answer 6

-Beating so fast that cardiac output is reduced
-Beating ineffectively so that coordination between the atria and ventricles or the ventricles themselves reduces cardiac output

Question 7

What are s/s of unstable tachycardia?

Answer 7

-Hypotension
-Acutely altered mental status
-S/O Shock
-Ischemic chest discomfort
-Acute Heart Failure

Question 8

What are 2 key points to recognize when managing the pt w/ unstable tachycardia?

Answer 8

-The pt is significantly symptomatic or stable
-The S/S are caused by the tachycardia

Question 9

*Quickly determine if the Tachycardia is producing hemodynamic instability & the S/S or if the serious S/S (e.g. the pain & distress of AMI) are the cause of the tachycardia.

Question 10

*A HR <150 is usually an appropriate response to physiologic stress (fever, dehydration) or other underlying conditions.

Question 11

Is cardioversion appropriate for the pt w/ sinus tachycardia?

Answer 11

NO! GIVE ADENOSINE!!

Question 12

If pulseless tachycardia is present, what is the rhythm to treat?

Answer 12

PEA

Question 13

What steps should be taken to identify & treat underlying causes of tachycardia?

Answer 13

-Maintain a patent airway & assist breathing as necessary
-Give O2 if Hypoxic
-Use cardiac monitor to identify rhythm
-Monitor B/P & oximetry (along w/ other VS)
-Obtain IV access
-Obtain 12 lead EKG

Question 14

What are the S/S to look for in persistent tachycardia?

Answer 14

-Hypotension
-Acutely altered MS
-S/O shock
-Ischemic chest discomfort
-Acute Heart Failure

Question 15

For unstable tachycardia that is refractory to synchronized cardioversion or adenosine what is the next treatment to consider?

Answer 15

-Increasing the energy level for the next shock
-Consider antiarrhythmic drugs
-Obtain expert consultation
-Search for underlying cause

Question 16

What is the treatment for tachycardia w/ a wide QRS >/= 0.12 sec?

Answer 16

-Adenosine (only if regular and monomorphic)
-Antiarrhythmic infusion (Amiodarone 150 mg over 10 minutes followed by maintenance infusion of 1mg/min for the 1st 6 hours)
-Expert consultation

Question 17

What are treatments to consider for treatment of stable tachycardia w/o a wide QRS?

Answer 17

-Vagal maneuvers (if regular)
-Adenosine (if regular)
-Beta Blocker or Calcium Channel Blocker
-Expert consultation

Question 18

What should be done for the pt w/ tachycardia w/ serious s/s R/T tachycardia & ventricular rate >150?

Answer 18

-Prepare for immediate SYNCRHONIZED CARDIOVERSION & premeditate whenever possible.
-May given a brief trial of medications based on specific arrhythmia.
-Immediate Cardioversion is generally not needed for HR <150.

Question 19

What is the difference between Synchronized and Unsynchronized Cardioversion?

Answer 19

Synchronized Cardioversion uses a sensor to deliver a shock that is synchronized w/ the peak of the QRS complex. Synchronization avoids delivering a shock during cardiac depolarization (T Wave) when there is a period of vulnerability in which a shock can precipitate VF. Synchronized shocks also use a lower energy level that attempted defibrillation.

Unsynchronized Cardioversion shocks are delivered as soon as the shock button is pushed. These shocks may fall randomly anywhere in the cardiac cycle and us higher energy levels that synchronized shocks.

Question 20

When are synchronized shocks recommended:

Answer 20

-For pts w/ a pulse and tachycardia such as:
—Unstable SVT
—Unstable A Fib
—Unstable A Flutter
—Unstable monomorphic tachycardia w/ pulses

Question 21

When should you avoid synchronized Cardioversion?

Answer 21

-Polymorphic VT
-Synchronization is impossible
-Delay in treatment in an unstable pt

Question 22

Unsynchronized high energy shocks are recommended for:

Answer 22

-A pt w/o a pulse—VT or pVT
-For a pt in clinical derterioration (in pre-arrest) such as those w/ severe shock or polymorphic VT
-When you think a delay in converting the rhythm will result in cardiac arrest.
For pt’s who are unstable or deteriorating & synchronization cannot be immediately accomplished
-When you are unsure whether monomorphic or polymorphic VT is present in the stable pt

Question 23

What is the difference between Sinus Tachycardia from Re-entry tachycardia (SVT):

Answer 23

-Sinus Tachycardia usually does not exceed 120-130 and has a gradual onset and gradual termination.
-Re-entry SVT has an abrupt onset and termination.