Tachycardia Algorithm
Tachycardia and its ACLS Algorithm
Tachycardia/tachyarrhythmia is defined as a rhythm with a heart rate greater than 100 bpm.
An unstable tachycardia exists when cardiac output is reduced to the point of causing serious signs and symptoms.
Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncope
One important question you may want to ask is: “Are the symptoms being caused by the tachycardia?” If the symptoms are being caused by the tachycardia treat the tachycardia.
There are many causes of both stable and unstable tachycardia and appropriate treatment within the ACLS framework requires identification of causative factors. Before initiating invasive interventions, reversible causes should be identified and treated.
Causes
The most common causes of tachycardia that should be treated outside of the ACLS tachycardia algorithm are dehydration, hypoxia, fever, and sepsis. There may be other contributing causes and review of the H’s and T’s of ACLS should take place as needed.
Administration of OXYGEN and NORMAL SALINE are of primary importance for the treatment of causative factors of sinus tachycardia and should be considered prior to ACLS intervention.
Once these causative factors have been ruled out or treated, invasive treatment using the ACLS tachycardia algorithm should be implemented.
Associated Rhythms
There are several rhythms that are frequently associated with stable and unstable tachycardia these rhythms include:
- Atrial fibrillation
- Atrial flutter
- Supraventricular tachycardia (SVT)
- Monomorphic VT
- Polymorphic VT
- Wide-complex tachycardia of uncertain type
Visit the links above to learn about each specific rhythm.
ACLS Treatment for Tachycardia
The fist question that should be asked when initiating the ACLS tachycardia algorithm is: “Is the patient stable or unstable?” The answer to this question will determine which path of the tachycardia algorithm is executed.
Patients with unstable tachycardia should be treated immediately with synchronized cardioversion. If a pulseless tachycardia is present patients should be treated using the pulseless arrest algorithm.
Patients with stable tachycardia are treated based upon whether they have a narrow or wide QRS complex. The following flow diagram shows the treatment regimen for stable tachycardia with narrow and wide QRS complex.
- Stable (narrow QRS complex) → vagal maneuvers → adenosine (if regular) → beta-blocker/calcium channel blocker → get an expert
- Stable (wide/regular/monomorphic) → adenosine → consider antiarrhythmic infusion → get an expert
What is SOA?
Short of air.
Why do you really treat wide vs narrow complex tachycardias different? Esp. in regards to vagal maneuvers
“Vagal maneuvers will not work with Vtach, and wide complex tachycardia should always be assumed to be VTach. 90% of the time it is VTach. Vagal Maneuvers only work 25% of the time with narrow complex tachycardia. If the pt. is unstable, the treatment is the same.”—Chris
I did read the comment below on rsvt and the rarity of it but that being said, when looking at a rhythm and diagnosing it how does one tell if it is an rsvt or svt just by looking at the rythym
Refractory simply means that when you attempt to treat the VT it responds to treatment and comes back quickly or it may not respond at all. It will look like VT which and the patient will be symptomatic (probably unconscious) and the HR will most of the time be greater than 150.—Jeff
What is SOA?
SOA means “shortness of air.” It means that the patient cannot breathe well.—Jeff
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What medication would you give if your patient has refractory ventricular tachycardia? And what does refractory mean?
Refractory Ventricular Tachycardia is rare and hard to treat. Refractory implies that drugs aren’t working, so in the ACLS situation, synchronized cardioversion or defibrillation depending on if there is a pulse, is the method of treatment. Expert consultation is necessary. Some options outside the scope of ACLS is Catheter Ablation, Implanted ICD. I haven’t had any patients that had refractory VT, but from cursory reading, it is seen in patients with chronic cardiac disease processes.