Adult Tachycardia Algorithm

Sequence of Tachycardia

Refer the flowchart mentioned below to get a clear idea about the management of adult tachycardia. Tachycardia is referred to a heart rate more than 100 beats per minute (BPM).It is faster than normal heart rate. Generally, Tachycardia is classified as follows:

• Narrow complex- In narrow complex tachycardia, QRS is less than 0.12 seconds on ECG.
• Wide complex- On ECG reports, QRS is found to be more than 0.12 seconds in wide complex tachycardia.

The following measures can be used during the treatment of Emergency tachycardia:

• Synchronized cardioversion
• Vagal Maneuvers
• Drugs include:
  1. Amiodarone
  2. Adenosine
  3. Procainamide

Tachycardia Sequence: As soon as tachycardia is found in patients during cardiac monitoring, the following tachycardia sequence should be followed:

1. Recognize and treat the underlying cause.
2. Examine the heart rate, rhythm and blood pressure.
3. Ensure oxygenation more than 94%.
4. Find out whether the tachycardia is stable or unstable. Altered level of consciousness, symptoms of shock or chest pain and hypotension may be found due to unstable tachycardia.

If unstable tachycardia is found in patients, then synchronized cardioversion should be performed without any delay.

• For narrow and regular QRS: cardiovert at 50-100 Joules.
• For narrow and irregular QRS: cardiovert at 120-200 Joules.
• For wide and regular QRS: cardiovert at 100 Joules.
• For wide and irregular QRS: turn off the synchronized mode and defibrillate.

If stable tachycardia is found in patients, then an IV or IO access for fluid and medication administration should be established.

• Establish an IV or IO access for fluid and medication administration.
• Adenosine should be given as 6 mg bolus form and if necessary, a second dose of 12 mg may be if given.
• If Adenosine is not found effective; in this case, Procainamide may be given at a dose of 20-50 mg with a maximum dose of 17 mg/kg and infusion of 1-4 mg/minutes is considered as maintenance dose or Amiodarone 150 mg over 10 minutes may be used with a second dose for recurrent Ventricular Tachycardia followed by infusion of 1 mg/min.
• Adenosine should be used for regular and QRS interval more than 0.12 seconds.
• An antiarrhythmic infusion should be considered.

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