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Housestaff Survival Guide | Crosscover | Tachycardia
First:
-assess pt and vitals: ABCDs, get EKG
-low BP or symptomatic (decreased alertness, pulm edema, chest pain) – call your senior, may need
DC conversion
-non-sustained V tach – check electrolytes and replace
-sustained (> 30 sec.) – assess hemodynamic stability; consider calling a code if pt is unstable
Hx:
chest pain, palpitations, SOB, previous episodes, h/o cardiac or thromboembolic disease, drug
hx (incl. recreational, caffeine, smoking, alcohol); assess for causes of sinus tach (pain,
hypovolemia, infection)
PE:
vitals, mentation, JVP, skin temp/cyanosis, cap refill, heart rate, murmurs, lung crackles and
breath sounds, edema or evidence of DVT
Tests:
ECG; consider CBC, glucose, Mg, Ca, Chem, (thyroid)?, ABG if low pulse ox or considering
PE, CXR
DDX:
Narrow Complex Tachycardia:
Regular: sinus tach, SVT, atrial flutter
Irregular: atrial fibrillation, MAT, a. flutter w/ variable conduction
Wide Complex Tachycardia:
do not miss V. Fib
Management: Call your senior and consider emergency cardioversion if hypotensive, unstable with
a fib with RVR or SVT or VT, or vent rate > 150
-oxygen, telemetry, correct electrolytes (Mg, K), underlying causes (infection, hypovolemia, PE),
address management for any primary arrhythmias
-A FIB: with RVR – rate control with diltiazem or beta-blocker if pt is stable
-SVT: may be broken with valsalva, carotid massage (r/o bruits 1st), adenosine 6mg IVP followed
by rapid saline flush, then repeat adenosine 12mg IVP if needed (record on a rhythm strip!!)
-VT without pulse or BP: ACLS management as V. Fib
-NSVT: if infrequent, monomorphic and pt is asymptomatic, check lytes and watch
-MAT: treat pulm disease, rate control (consider CCB like diltiazem, or B-blocker)