lV-70 Circulation December 13, 2005 wIth Pulses Assess and support ABCs as needed ve oxyg Monitor ECG (identity rhythm). blood pressure, oximetry Identify and treat reversible cause synchronized cardioversion Establish IV access and give Obtain 12-lead E Unstable signs include altered mental status, ongoing chest pain. is conscious: do not delay Is ORS narrow(c0. 12 sec)? Note: rate-related symptoms Consider expert consultation uncommon if heart rate <1 50/min see Pulseless Arrest Algorith NARROW ORS: Is Rhythm Regular? Expert consultation Give adenosine 6 mg rapid Ⅳpush. if no conversion give 12 mg rapid IV push: possible atrial flutter or MAT If atrial fibrillation with may repeat 12 mg dose once cal aberrancy Control rate (eg, dil ncertain rhythm Amiodarone Complex Ta arrow See Irregular t B-blockers: use B-biockers w 150 mo I over 10 mun or l 22 expert consultation r ele fibrillation (AF.WPw carryover Avoid AV nodal If sVT with aberrancy If rhythm does NOT convert, Give adeno probable reentry SVT possible atrial flutter. (go to Bo 7) mics(eg, amiodarone Terrene Control rate fog, Treat recurrence with B-blockers: use p-biookers with adenosine or longer caution in pulmonary disease consuitation acting AV nodal blockno i torsades de poin Consider expert consultation ad with 1-2 g over 5-60 min, then intusion) te: If patient be able, go to Box 4. Hydrogen ion (acidosis)-Tension pneumothorax Figure 2. ACLS Tachycardia Algorithm. The provider must assess the patient while supporting the tachycardia(Box 3). If the a s chest iate synchronized car tient demonstrates rate-related irway and breathing, administering oxygen(Box 2), obtain- cardiovascular compromise, ns and symptoms such ing an ECG to identify the rhythm, and monitoring blood altered mental status, ongoing chest pain, hypotension, or pressure and oxyhemoglobin saturation. The provider should other signs of shock, provide immediate synchronized car- establish IV access when possible and identify and treat diversion(Box 4--see below ) Serious signs and symptom reversible causes of the tachycardia. are uncommon if the ventricular rate is <150 beats per If signs and symptoms persist despite provision of supple minute in patients with a healthy heart. Patients with impaired mentary oxygen and support of airway and provider should determine if the patient is signs of cardiovascular compromise are unstable a on, the cardiac function or significant comorbid conditions may and if become symptomatic at lower heart rates. If the patient is unstable with narrow-complex reentry SVT, you may admin-The provider must assess the patient while supporting the airway and breathing, administering oxygen (Box 2), obtain￾ing an ECG to identify the rhythm, and monitoring blood pressure and oxyhemoglobin saturation. The provider should establish IV access when possible and identify and treat reversible causes of the tachycardia. If signs and symptoms persist despite provision of supple￾mentary oxygen and support of airway and ventilation, the provider should determine if the patient is unstable and if signs of cardiovascular compromise are related to the tachycardia (Box 3). If the patient demonstrates rate-related cardiovascular compromise, with signs and symptoms such as altered mental status, ongoing chest pain, hypotension, or other signs of shock, provide immediate synchronized car￾dioversion (Box 4—see below). Serious signs and symptoms are uncommon if the ventricular rate is
150 beats per minute in patients with a healthy heart. Patients with impaired cardiac function or significant comorbid conditions may become symptomatic at lower heart rates. If the patient is unstable with narrow-complex reentry SVT, you may admin￾Figure 2. ACLS Tachycardia Algorithm. IV-70 Circulation December 13, 2005