From the Guidelines
For a patient with tachycardia, following the Advanced Cardiovascular Life Support (ACLS) algorithm, the initial step is to assess the patient's stability and determine if the tachycardia is the primary cause of the presenting symptoms or secondary to an underlying condition, as outlined in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Initial Assessment
The evaluation and management of tachyarrhythmias is depicted in the ACLS Tachycardia With Pulse Algorithm, which emphasizes the importance of determining the patient's clinical significance and potential reversible causes of the tachycardia 1. This includes assessing signs of increased work of breathing and oxyhemoglobin saturation as determined by pulse oximetry.
Treatment Approach
If the patient is unstable with signs like hypotension, altered mental status, chest pain, or heart failure, immediate synchronized cardioversion at 100-200 joules (biphasic) would be ordered, as this is a critical step in managing unstable tachycardia according to the ACLS guidelines 1. For stable patients, obtaining a 12-lead ECG is crucial to determine the rhythm and guide further treatment.
Rhythm-Specific Treatment
- For stable narrow complex tachycardia, vagal maneuvers followed by adenosine 6 mg IV rapid push if needed would be the initial approach, considering the effectiveness of these methods in converting supraventricular tachycardia to a normal sinus rhythm 1.
- For stable wide complex tachycardia, amiodarone 150 mg IV over 10 minutes could be considered, given its efficacy in managing ventricular tachycardia, followed by a maintenance infusion of 1 mg/min for 6 hours.
Ongoing Care
Throughout treatment, continuous cardiac monitoring, oxygen therapy, IV access, and frequent vital sign checks are essential to ensure the patient's condition is closely observed and managed appropriately, as emphasized by the ACLS guidelines 1. The ultimate goal is to identify and address the underlying cause of the tachycardia while stabilizing the patient and improving cardiac output and tissue perfusion.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Tachycardia Treatment According to ACLS Algorithm
- The Advanced Cardiovascular Life Support (ACLS) algorithm provides guidelines for treating tachycardia, including ventricular tachycardia (VT) and atrial fibrillation with rapid ventricular response (RVR) 2, 3.
- For patients with wide QRS complex tachycardia and hemodynamic instability, the ACLS algorithm recommends immediate synchronized cardioversion 3.
- In cases of ventricular fibrillation or unstable ventricular tachycardia, especially in patients with congenital long-QT syndrome, a modified ACLS algorithm may be necessary 4.
- For rate control in atrial fibrillation with RVR, calcium channel blockers and β-blockers are effective options, with diltiazem potentially achieving rate control faster than metoprolol 5.
Doctor's Order for Tachycardia
- A doctor's order for a patient with tachycardia may include synchronized cardioversion, anti-arrhythmic medications, or rate control medications such as calcium channel blockers or β-blockers, depending on the specific diagnosis and patient condition 2, 3, 5.
- The order should be based on the ACLS algorithm and take into account the patient's underlying condition, such as congenital long-QT syndrome, and any potential contraindications to certain treatments 4.