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.
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.
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