Therapeutic Handbook - GGC Prescribing

Tachycardia – treatment algorithm (with pulse)Reproduced with the kind permission of the Resuscitation Council (UK) www.resus.org.ukResuscitation and Anaphylaxis• Assess using the ABCDE approach• Give oxygen if appropriate and obtain IV access• Monitor ECG, BP, SpO 2, record 12-lead ECG• Identify and treat reversible causes (e.g. electrolyte abnormalities)YES / UnstableSynchronised DC Shock*Up to 3 attempts• Amiodarone IV 300 mg over 10 - 20minutes and repeat shock;followed by:• Amiodarone 900 mg IV over 24 hoursAdverse features?• Shock• Syncope• Myocardial ischaemia• Heart failureNO / StableIs QRS narrow (< 0.12 sec)?Broad QRS -Is rhythm regular?Narrow QRS -Is rhythm regular?IrregularSeek expert helpPossibilities include:• AF with bundle branch block– treat as for narrow complex• Pre-excited AF– consider amiodarone• Polymorphic VT(e.g. torsades de pointes –give magnesium IV 2 gover 10 minutes)IrregularIrregular Narrow ComplexTachycardiaProbable atrial fibrillationControl rate with:• Beta-blocker or diltiazem• Consider digoxin oramiodarone if evidence ofheart failure.Regular – next pageRegular – next page*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia.Page 22