Supraventricular Tachycardias (SVT)

  1. Vagal Maneuvers: Attempt vagal maneuvers like the Valsalva maneuver, carotid sinus massage, or cold stimulus to the face.
  2.  Adenosine: Administer adenosine as a rapid intravenous (IV) bolus. It’s often the first-line medication for SVT.
  3. Beta-Blockers or Calcium Channel Blockers: In stable cases, oral or IV beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem) may be used.

Atrial Fibrillation (AF) and Atrial Flutter

  1. Rate Control: Use medications such as beta-blockers, calcium channel blockers, or digoxin to control increased heart rate.
  2. Rhythm Control: Administer anti-arrhythmic medications like amiodarone or flecainide to restore and maintain normal sinus rhythm.
  3. Anticoagulation: Consider anticoagulant therapy to prevent thromboembolic events in patients with Atrial fibrillation at risk.

Ventricular Tachycardia (VT)

  1. Stable VT: Administer anti-arrhythmic drugs like amiodarone or lidocaine.
  2. Unstable VT: Perform synchronized cardioversion using appropriate energy levels.
  3. Consider Magnesium: Consider IV magnesium sulfate in cases of torsades de pointes or suspected magnesium deficiency.

Sinus Tachycardia:

  1. Identify and Treat Underlying Cause: Address and manage the underlying condition causing sinus tachycardia, such as pain, fever, or anxiety.
  2. Beta-Blockers: Consider beta-blockers if appropriate for symptom control.
ACLS Tachycardia Algorithm

The AHA ACLS Tachycardia with a pulse algorithm gives a clear and step-by-step approach to assess and treat patients with a fast heart rate. Start with immediate basic support (airway, breathing, oxygen if hypoxemic), place the patient on a monitor, get IV access, and a 12-lead ECG as soon as possible.

Key Steps in the ACLS Tachycardia Algorithm:

1. Immediate Basic Support

  1. Maintain an open airway.
  2. Assist breathing as needed.
  3. Administer oxygen if the patient is hypoxemic.
  4. Place the patient on a cardiac monitor to identify rhythm and monitor blood pressure and oxygen saturation.
  5. Establish IV access.
  6. Obtain a 12-lead ECG as soon as possible.

2. Assess Patient Stability

  1. Determine if the patient is stable or unstable.
  2. Signs of cardiovascular instability include hypotension, signs of shock, acute heart failure, altered mental status, or ischemic chest pain

3. Unstable Trachycardia

A heart rate typically above 150 bpm with signs of poor blood flow, such as hypotension, chest pain, shortness of breath, or altered mental status.

Immediate Action: Perform synchronized cardioversion promptly.

  1. For narrow regular QRS: 50–100 J.
  2. For narrow irregular QRS: 120–200 J.
  3. For wide regular QRS: 100 J.
  4. For wide irregular QRS: Immediate defibrillation (not synchronized).

4. Stable Trachycardia

For stable patients, further assess the QRS complex width and rhythm.

If QRS is narrow (< 0.12 seconds) and regular:

  1. Attempt vagal maneuvers.
  2. If unsuccessful, administer adenosine IV bolus (6 mg rapid push followed by saline flush, then 12 mg if needed).
    Consider beta-blockers or calcium channel blockers if tachycardia recurs.

If QRS is wide (≥ 0.12 seconds):

  1.  Consider expert consultation.
  2. Administer antiarrhythmic infusion such as procainamide (20-50 mg/min IV), amiodarone (150 mg IV over 10 minutes), or sotalol IV (100 mg over 5 minutes).

5. Continuous Monitoring and Addressing Underlying Causes

  1. Continuously monitor ECG, vital signs, and oxygenation.
  2. Identify and treat any underlying reversible causes (Hs, Ts) contributing to tachycardia.

Medications are essential in treating tachycardia for stable patients or after electrical treatments. These drugs help control the heart rate, restore normal rhythm, and prevent complications. Using the right medication at the right time improves patient outcomes.

Common Medications For Acls Tachycardia

  1. Adenosine
  2. Amiodarone
  3. Procainamide
  4. Sotalol
  5. Beta-blockers (e.g., Metoprolol)
  6. Calcium channel blockers (e.g., Diltiazem)

The ACLS adult tachycardia algorithm offers a clear, step-by-step approach to assess and manage patients experiencing rapid heart rhythms. It is crucial to understand when to provide basic support, how to evaluate patient stability, and when to apply medications or electrical therapy to improve outcomes during tachycardia emergencies. Mastery of this algorithm ensures timely and effective treatment that can save lives.

The ACLS Tachycardia Algorithm is an essential tool for healthcare professionals aiming to build confidence and hands-on skills in managing tachycardia emergencies. By joining CPRVAM, you gain access to expert-led courses offering practical training and comprehensive knowledge, helping you become proficient in advanced cardiac life support. Start your learning journey today and be prepared to respond swiftly and effectively when every second counts.

The first treatment for unstable tachycardia is synchronized cardioversion. This is an electrical shock given at the right moment in the heartbeat to quickly restore a normal heart rhythm and improve symptoms. It is used when the fast heart rate is causing serious problems like low blood pressure or chest pain.

A heart rate over 150 beats per minute, especially with symptoms like chest pain, low blood pressure, or shortness of breath, may be dangerous and needs quick treatment.

Treatments may include giving oxygen, using medications to slow the heart rate, or applying electrical therapy like synchronized cardioversion if the patient is unstable.

It is used when an adult patient’s heart rate is faster than normal and is causing symptoms or could lead to serious problems.

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