Diferencia entre revisiones de «ACLS: tachycardia»
m (moved Tachycardia (with Pulse) to ACLS: Tachycardia) |
Sin resumen de edición |
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| Línea 4: | Línea 4: | ||
#Is the rhythm regular or irregular? | #Is the rhythm regular or irregular? | ||
==Narrow Regular== | ==Narrow== | ||
===Narrow Regular=== | |||
#'''See also [[Tachycardia (Narrow)]]''' | #'''See also [[Tachycardia (Narrow)]]''' | ||
# Sinus Tachycardia | # Sinus Tachycardia | ||
| Línea 16: | Línea 17: | ||
##Synchronized [[Cardioversion]] (50-100J) | ##Synchronized [[Cardioversion]] (50-100J) | ||
==Narrow Irregular == | ===Narrow Irregular === | ||
# MAT | # MAT | ||
##Treat underlying cause (hypoK, hypomag) | ##Treat underlying cause (hypoK, hypomag) | ||
| Línea 28: | Línea 29: | ||
##Synchronized [[Cardioversion]] (120-200 J) | ##Synchronized [[Cardioversion]] (120-200 J) | ||
==Wide Regular== | ==Wide== | ||
===Wide Regular=== | |||
*If unstable: shock (synchronized 100J) | *If unstable: shock (synchronized 100J) | ||
**Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure) | **Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure) | ||
| Línea 43: | Línea 45: | ||
**Synchronized [[Cardioversion]] (100J) | **Synchronized [[Cardioversion]] (100J) | ||
==Wide Irregular== | ===Wide Irregular=== | ||
*DO NOT use AV nodal blockers | *DO NOT use AV nodal blockers | ||
**Can precipitate V-Fib | **Can precipitate V-Fib | ||
Revisión del 06:46 12 ene 2012
3 questions
- Is the pt in a sinus rhythm?
- Is the QRS wide or narrow?
- Is the rhythm regular or irregular?
Narrow
Narrow Regular
- See also Tachycardia (Narrow)
- Sinus Tachycardia
- Treat underlying cause
- SVT
- Vagal maneuvers (convert up to 25%)
- Adenosine 6mg IVP (can follow with 12mg if initially fails)
- If adenosine fails initiate rate control with CCB or BB
- Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
- Metoprolol 5mg IVP x 3 followed by 50mg PO
- If adenosine fails initiate rate control with CCB or BB
- Synchronized Cardioversion (50-100J)
Narrow Irregular
- MAT
- Treat underlying cause (hypoK, hypomag)
- Sinus Tachycardia w/ frequent PACs
- A fib / A Flutter w/ variable conduction
- Rate control with:
- Dilt
- MTP (good in setting of ACS)
- Amiodarone (good in setting of hypotension, CHF)
- Digoxin (good in setting of CHF)
- Synchronized Cardioversion (120-200 J)
- Rate control with:
Wide
Wide Regular
- If unstable: shock (synchronized 100J)
- Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
- If stable:
- Meds
- Procainamide
- 20-50mg/min; then maintenance infusion of 1mg/min x6hr
- Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given
- Avoid if prolonged QT or CHF
- Amiodarone
- 150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
- Adenosine
- May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
- Procainamide
- Synchronized Cardioversion (100J)
- Meds
Wide Irregular
- DO NOT use AV nodal blockers
- Can precipitate V-Fib
- A fib w/ preexcitation
- 1st line - Electric cardioversion
- 2nd line - Procainamide, amiodarone, or sotalol
- A fib w/ aberrancy
- Polymorphic V-Tach / Torsades
- Emergent defibrillation (NOT synchronized)
- Correct electrolyte abnormalities
- HypoK, hypoMag
- Stop prolonged QT meds
See Also
Source
2010 AHA ACLS Guidelines