Cardiovascular Critical Care I
N
Assess appropriateness for clinical condition
Heart rate typically > 150 bpm if tachyarrhythmia
Identify and treat underlying cause
•
Maintain patent airway; assist breathing as necessary
•
Oxygen as indicated
•
Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
Persistent tachyarrhythmia causing:
•
Hypotension?
•
Acutely altered mental status?
•
Signs of shock?
•
Ischemic chest discomfort?
•
Acute heart failure?
IV access and 12-lead ECG if available
Vagal maneuvers
Adenosine (if regular)
Beta-blocker or calcium channel blocker
Consider expert consultation
IV access and 12-lead ECG if available
Consider adenosine only if regular and
monomorphic
Consider antiarrhythmic infusion
Consider expert consultation
Synchronized Cardioversion*
Consider sedation
If regular narrow complex,
consider adenosine
N
Wide QRS?
0.12 seconds
Y
*Initial Recommendations:
Narrow regular: 50-100 J
Narrow irregular: 120-200 J biphasic or
200 J monophasic
Wide regular: 100 J
Wide irregular: Defibrillation dose
N
Y
Medication Doses/Details
Adenosine IV Dose
Sotalol IV Dose
First dose = 6 mg rapid IVP, follow with NS flush
Second dose = 12 mg if required
100 mg (1.5 mg/kg) over 5 minutes
Avoid if prolonged QT
Amiodarone IV Dose
Procainamide IV Infusion Dose (for stable wide-QRS)
First dose: 150 mg over 10 minutes
Repeat as needed if VT recurs
Maintenance infusion: 1 mg/min for 6 hours
20-50 mg/min until arrhythmia suppressed,
hypotension ensues, QRS duration increases > 50%,
or maximum dose of 17 mg/kg given
(typical maximum dose 1000 mg)
Maintenance infusion: 1-4 mg/min
Avoid if prolonged QT or HF
Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Circulation
2021;142(16_suppl_2):S366-468).