Tachycardia

Question 1

Define/Adverse effects/Causes of Unstable Tachycarida

Answer 1

-HR is greater than/equal to 150
-When unstable –> can lead to decreased CO –> pulmonary edema/chest pain (coronary ischemia), and hypotension
-Causes: fever, anemia, hypotension, blood loss, ect.

Question 2

S/S of tachycardia

Answer 2

-tachypnea, intercostal retractions, suprasternal retractions, abdominal breathing, and hypoxemia

Question 3

Describe the pathway for tachycardia

Answer 3

1. identify cause
2. maintain 02 > 94%
3. identify if stable vs. unstable (hypotension, decreased LOC, shock, and CP)
4. unstable: cardioversion
5. stable: vasovagal/meds

Question 4

How to treat unstable Tachycardia?

Answer 4

Cardioversion
-narrow QRS (<.12) and regular: cardiovert at 50-100 joules
-narrow QRS (<.12) and irregular: cardiovert at 120-200 joules
-QRS wide (greater than/equal to .12) and irregular: defibrillate + CPR

Question 5

How to treat stable Tachycardia? Narrow vs. Wide QRS

Answer 5

-Attempt vagal maneuvers/ carotid massage for narrnow QRS
-IV/IO access –> adenosine 6 mg bolus and second dose of 12 mg
-narrow QRS –> beta blockers/CCB
-wide QRS: procainamide 20-50 mg/min IV (do not use with stable wide tachy w/ prolonged QT)
-wide QRS: Amiodarone 150 mg IV over 10 minutes
-Wide QRS: Sotolol 100 mg (1.5 mg/kg) over 5 minutes