Adult Tachycardia With a Pulse Algorithm eee ‘Synchronized car Initial recommen * Narrow regular: * Narrow irregular biphasic or 200 + Wide regular: 1¢ © Wide irregular: ¢ dose (not synch Adenosine IV dos First dose: 6 mg r follow with NS flu Second dose: 12 Antiarrhythmic I Persistent Stable Wide-QRS pectryeriy nate come, Procainamide IV ‘+ Hypotension? 20-50 mg/min unt ‘= Acutely altered mental status? ‘suppressed, hypo! ‘+ Signs of shock? QRS duration incr maximum dose 17 Maintenance infus Avoid if prolonged Amiodarone IV di First dose: 150 mi Repeat as needed Follow by mainten 4 mg/min for first: Sotalol IV dose: 100 mg (1.5 mg/k« Avoid if prolonged (© 2015 American Heart AssociationTachycardia ~ Give 02 ~ Monitor EKG, blood pressure, oximeter, capnomelry = Could this bet A: Assess Airway : ? wearer B: Hypoventilabon “hyperthermia? ©: Cardiac outputiprelond aah pense gig D: Drugs (anaphylaxis) + auto-PEEP? - Perform Echo of TEE if possible = Pertorm Immediate ‘Altered mental stanus? ‘Synchronized Cardioversion Chest pain? = Verily of obtain IV access Hypotersian? ~ Conekder expert comeunanon = Ht patiant becomes pulseless, ee ‘Comprehensive agora * Warify or obtain IV acca + Obtain 12 load EGHhythi stip de (20.12 sec) = Regular = Wrregutar Consider vagal manguvers. atrial fibrilason ve atrial tamer vs NAT + Give adenosine 6 rng IV push = Sow gjnction fraction or sewere: no rasponte, give adenosine || hypotensice: load Amiodarone || _ ventricular 120mg (push 18d rag IV ower 10 erin inne = etna iitetian win aberrancy, see ire gular uncertain tyttm || narrawcompiox + normal EF and acoepiable BP: aor bate sere cree |) Sse Amyacarons | anteata ‘channel blocker and Calcium = Torsades-de-Pointes, choose 1401 |] Give Magnesium Sulla 29 IV aver 8 - Amio minutes (ep patient -Atmytn doas NOT convert, Skaly | | mie fad bapelie prolonged = Ue e-entont VT aria fuer, EAT, or ancl toe Gia’ ren oe maikg VQ3-5 — || repeat dose. calalum channel blocker, consider | J min x2 «it pre-exclted atrial > Treat recurrence with (infusion Aeocuie rear acing ai | [-Fe-vabatanventonstie | |-Peeae ie, cn node Bockers (2.9, Bata Ureeycg outer cardioversion 150mg IV aver 10 blocker ar ditiazem min and expert -navtwin consultation aberrancy, give adenosine 6 or 12 9 IV push, Reconsider A, B, ©, D from above = Obsarva for recurrence:PULSELESS ARREST * BLS Algorithm: Call for help, give CPR * Give oxygen whan available * Attach montor/defiorilator when available Shookable Not Shockable Give 1 shock ‘© Manual biphasic: device specific (typically 120 to 200.) Note: unknown use 200 + AED: device spectic ‘= Monophasic: 360 J Resume CPR immedi Resume CPR immediately for 5 cyoles When IVAO available, give vasopressor + Epinephrine 1 mg 1V/IO Repeat every 3 t0 5 min or ‘+ May give 1 dose of vasopressin 40 UIV/I0 to replace frst or second dose of epinephrine Consider atropine 1 mg IV/1O for asystole or slow PEA rate Repeat every 3 to 5 min (up to S doses) Continue CPR while deforilator Ie charging Give 1 shock ‘= Manuel biphasic: device speciic (came as frst shock or higher dose) Note: W unknown use 200 + AED: device specific = Monophasie: 360 J Resume CPR immediately after the shock ‘When IVO available, give vasopressor curing CPR (before or after the shock) * Epinephrine 1 mg IVIO Repeat every 3 to § min + May give 1 dose of vasopressin 40 U IV/IO to replace frst or second dose of epinephrine Give 5 cycles of CPR * If asystole, go to Box 10 2 * If electrical activity, check Goto pulse. Ino pulse, goto Box 4 Box 10 + If pulse present, begin ostresuscitation care Give 5 cycles of CPR During CPR ‘+ Push hard and fast (100/min) ‘+ Rotate compressors RG aa erase 2 minutes with rythm checks ‘+ Search for and treat possible ‘+ Minimize interruptions in chest eae ‘contributing factors = Hypovolemia Continue CPR while defiorilator Is charging Give 1 shock * Manual biphasic: device speci (came as frst shock or higher dose) Note: known, se 200 ‘= AED: device specific = Monophasie: 360 J Resume CPR immediately after the shock Consider antiartiythmics; give during CPR (Gefors or ater the shock) ‘amiodarone (200 mg I/O once, then ‘consider additional 180 mg IMO once) or lidocaine (1 to 1.5 ma/ka frst dose, then 0.5 to (0.7 mg/kg IV/O, maximum 3 doses or 3 ma/kg) Consider magnesium, loading dose 4 10.2 ¢ IVAO for torsades de pointes Atter 5 cycles of CPR,” got to Box 5 above + Ono cyole of CPR: 30 comoressions ox then 2 eats eles "2 min Hydrogen on (cid) + Avoid hyperventiation = Hypo /nyparkalemia + Secure sinvay and canfim placement pyDagleen® an after an advanced airway is placed, Eacall epacayet facet toy tgtt Steck peimchom, ‘of CPR. Give continous chest com- ay pressions without pauses for breaths. penoney) Give 8 to 10 breaths/minute. Check hae thythm every 2 minutes.