) may be due to rhythm abnormalities that can occur during the peri-arrest period. The tachycardia algorithm has been designed to enable the non-specialist ALS provider to treat a patient effectively and safely in an emergency.
The first step in assessing and treating all deteriorating or critically ill patients is to use the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).
If the patient does have adverse features this implies that the patient’s condition is unstable and they are at risk of deterioration. So the next course of action is synchronised cardioversion.
The Sinus Tachycardias
If cardioversion fails to terminate the arrhythmia and adverse features persist, administer 300 mg amiodarone IV over 10-20 min and perform a repeat synchronised cardioversion. The loading dose of amiodarone can be followed by an infusion of 900mg over 24 h.
The next stage in the algorithm (for both broad and narrow QRS) will ask you to determine if the patient’s rhythm is regular or irregular.
A regular broad complex tachycardia may be ventricular tachycardia (VT) or a supraventricular rhythm with bundle branch block. In a stable patient, if there is uncertainty about the origin of the arrhythmia, intravenous adenosine during a multi-lead ECG recording may clarify the nature of the rhythm. This should be done under expert supervision.
Normal Sinus Rhythm With Ventricular Ectopics
Otherwise, treat with amiodarone 300 mg IV, administered over 20 - 60 minutes, followed by a further 900 mg over 24 h.
If the same rhythm in this patient has previously been confirmed to be supraventricular tachycardia (SVT) with bundle branch block, give adenosine IV as first-line treatment, as described for treatment of a regular narrow complex tachycardia.
If the QRS is narrow and the rhythm is regular, in the absence of adverse symptoms you should start with vagal manoeuvres, recording a multi-lead ECG during performance of these.
Sick Sinus Syndrome: Symptoms, Causes And Treatment
If the arrhythmia persists and is not atrial flutter, give adenosine 6 mg as a very rapid intravenous bolus, recording a multi-lead ECG during the injection. If there is no response give a 12 mg bolus. If necessary give a further 12 mg dose if there is no response.
If either vagal manoeuvres or adenosine restores sinus rhythm, the rhythm was probably re-entry paroxysmal SVT. You should record a 12-lead ECG in sinus rhythm and can give further adenosine if the arrhythmia recurs. Consider carefully whether or not anti-arrhythmic prophylaxis will be of benefit in the setting of the individual patient. If uncertain, seek expert help.
If the arrhythmia persists and is not atrial flutter, give adenosine 6 mg as a very rapid intravenous bolus, recording a multi-lead ECG during the injection. If there is no response give a 12 mg bolus. If necessary give a further 12 mg dose if there is no response.
If either vagal manoeuvres or adenosine restores sinus rhythm, the rhythm was probably re-entry paroxysmal SVT. You should record a 12-lead ECG in sinus rhythm and can give further adenosine if the arrhythmia recurs. Consider carefully whether or not anti-arrhythmic prophylaxis will be of benefit in the setting of the individual patient. If uncertain, seek expert help.
