Adult Tachycardia with a Pulse Algorithm

Adult Tachycardia with a Pulse Algorithm

The ACLS Tachycardia Algorithm is used for patients who have marked tachycardia, usually greater than 150 beats per minute, and a palpable pulse. Some patients may have cardiovascular instability with tachycardia at heart rate less than 150 bpm.

A. Assess clinical condition. Perform an assessment for a clinical condition. A heart rate of 150 beats per minute is more likely to be symptomatic.

B. Identify and treat the underlying cause. Identify and treat any underlying cause. Maintain patent airway and give oxygen if hypoxemic . Place the patient on cardiac monitors to identify the rhythm and monitor blood pressure and oximetry.

C. Is persistent tachyarrhythmia causing symptoms? If the tachycardia is persistent, check for symptoms that may be caused by the tachycardia such as hypotension, altered mentation, signs of shock, ischemic chest discomfort, or acute heart failure. If unstable, cardiovert.

D. No. Wide QRS? If the tachyarrhythmia is not causing symptoms and the patient is stable, determine if the QRS is .12 or more.

  1. Wide-complex tachycardia. Establish IV access and obtain a 12-lead ECG if it’s available. If the QRS is greater than .12, and if the patient’s rhythm is regular and monomorphic, consider administering adenosine. Can also consider antiarrhythmic infusion and expert consultation.
  2. Narrow QRS Establish IV access and obtain a 12-lead ECG if it’s available. If the QRS is less than .12, consider vagal maneuvers or adenosine if regular.  Consider using a beta blocker or calcium channel blocker if tachycardia is refractory. Expert consultation.

E. Yes. Synchronized Cardioversion. If symptoms are present, the patient is unstable. Proceed with synchronized cardioversion. Establish IV access and administer sedation if the patient is conscious. If the patient is  unstable, cardiovert without sedation if necessary. If the patient has a regular narrow complex rhythm or a monomorphic wide complex rhythm and has normal vitals, consider administering adenosine while preparing for synchronized cardioversion.

Need something? Let's Talk!