Advanced Life Support

narrow complex tachycardia *Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia Seek expert help Yes No Unst...

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european resuscitation council

Advanced Life Support Tachycardia Algorithm • Assess using the ABCDE approach • Ensure oxygen given and obtain IV access • Monitor ECG, BP, SpO2 , record 12 lead ECG • Identify and treat reversible causes (e.g. electrolyte abnormalities)

Synchronised DC Shock*

Unstable

Up to 3 attempts

• Amiodarone 300 mg IV over 10-20 min and repeat shock; followed by: • Amiodarone 900 mg over 24 h

Irregular



Assess for evidence of adverse signs 1. Shock 2. Syncope 3. Myocardial ischaemia 4. Heart failure

Is QRS narrow (< 0.12 sec)?

Stable

Broad

Narrow

Broad QRS Is QRS regular?

Narrow QRS Is rhythm regular?

Regular

• Use vagal manoeuvres • Adenosine 6 mg rapid IV bolus; if unsuccessful give 12 mg; if unsuccessful give further 12 mg. • Monitor ECG continuously

Seek expert help

Possibilities 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 2 g over 10 min)

*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia

Regular

If Ventricular Tachycardia (or uncertain rhythm): • Amiodarone 300 mg IV over 20-60 min; then 900 mg over 24 h If previously confirmed SVT with bundle branch block: • Give adenosine as for regular narrow complex tachycardia

Normal sinus rhythm restored?

Irregular

Irregular Narrow Complex Tachycardia Probable atrial fibrillation Control rate with: • ß-Blocker or diltiazem • Consider digoxin or amiodarone if evidence of heart failure Anticoagulate if duration > 48h

No

Seek expert help

Yes

Probable re-entry PSVT: • Record 12-lead ECG in sinus rhythm • If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis

Possible atrial flutter • Control rate (e.g. ß-Blocker)

www.erc.edu | [email protected] | Published October 2010 by European Resuscitation Council Secretariat vzw, Drie Eikenstraat 661, 2650 Edegem, Belgium | Product reference: Poster_10_ALS-TACH_01_01_ENG Copyright European Resuscitation Council