How to Use Master ACLS How to get the most out of this website! Fast Review or In-depth study
In-Depth ACLS Videos Full length video lectures covering the prerequisite ACLS knowledge
ACLS Acronyms Crack the code for the ACLS Acronyms
Changes to ACLS Algorithms in 2015-2020 Covers the 2015 Guidelines & the 2017 Update to the 2015 Guidelines
2018 Update to the AHA/ILCOR Guidelines Summary of the 2018 Updates to the AHA Guidelines
ACLS Pharmacology Complete coverage of ACLS drugs including Drug Quick Facts
Basic Life Support BLS the foundation for all ACLS
Respiratory Distress and Arrest How Respiratory Distress contributes to & causes Cardiac Arrest
Acute Coronary Syndrome Causes & treatments for cardiac ischemia
Acute Stroke Stroke symptoms, testing, & treatments
Cardiac Arrest Algorithm Causes of cardiac arrest and how to treat them
Bradycardia Algorithm Identify when to treat a slow heart beat & how & when to treat it
Tachycardia Identify when to treat a fast heart beat & how & when to treat it
Care Of the Patient After Return of Spontaneous Circulation (ROSC) You've got a pulse, what now?
Additional Learning Resources Flashcards for fast learning
Defibrillation vs. Syncrhonized Cardioversion Electrical therapies--which one to use and how to use them
ACLS Megacode Practice Scenarios Learn to be a great Megacode Team Leader with NO STRESS
- ACLS Practice Megacode Scenarios
- ACLS Megacode Scenario 1
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ACLS Video Simulation Learning Center Megacode Videos for ACLS Simulation Learning--fast paced & fun!
ACLS Practice and Final Exams Hundreds of practice test questions. Retake as often as needed!
Adult Tachycardia With a Pulse
Tachycardia, also known as, tachyarrhythmia is defined as a heart rate greater than 100 bpm. Tachycardias may be stable or unstable. An unstable tachycardia results when the heart is beating so fast that the cardiac output is reduced and this causes serious signs and symptoms such as: chest pain, SOB, signs of shock, change in LOC, weakness or severe fatigue, syncope, or hypotension.
The healthcare provider must first determine if the signs and symptoms are being caused by the tachycardia or if the tachycardia is being caused by an underlying condition. For instance, a fever can cause tachycardia that may cause serious symptoms. The treatment, however, is not to treat the tachycardia but to treat the fever which will result in the tachycardia resolving itself. While providing patient support such as oxygen for hypoxia and SOB, it is always important to identify and treat reversible causes of tachycardias. The most common reversible causes of tachycardias are: sepsis, fever, dehydration, and hypoxia. Administration of oxygen and IV infusion of normal saline are the two most common initial therapies for tachycardia. If the serious signs and symptoms persist after treating the reversible underlying causes the Tachycardia Algorithm should be started.
There are several arrhythmias that may be associated with tachycardia. These include:
- Supraventricular Tachycardia (SVT)
- Atrial Flutter
- Atrial Fibrillation
- Wide Complex Tachycardia both Monomorphic Ventricular Tachycardia (VT) and Polymorphic Ventricular Tachycardia (VT)
Note: Both monomorphic VT and polymorphic VT may or may not be perfusing. If they are not perfusing go to the Cardiac Arrest Algorithm. The Tachycardia Algorithm is only for perfusing rhythms. You can click on the links above to read more about each type of tachycardia. Click on this link to see the flow chart for Adult Tachycardia With a Pulse Flow Chart.
The first question a healthcare provider always needs to ask is, “Is the patient stable or unstable?” This determine which pathway on the Adult Tachycardia with a Pulse Flow Chart to use.
Stable narrow-complex tachycardia (SVT) is treated with:
- Vagal maneuvers
- Calcium Channel Blockers (or beta blockers but watch the Blood Pressure)
- Expert Consultation
Stable wide-complex tachycardia is treated with:
- Antiarrhythmic Infusion (amiodarone, magnesium, or lidocaine)
- Expert Consultation
Beta blockers, calcium channel blockers, and AV nodal blocking agents may cause severe bradycardia in patients with irregular tachycardias and should be used only with great caution.
If the patient is unstable they should be treated immediately with Synchronized Cardioversion or Defibrillation based on whether the perfusing tachycardia is regular or irregular. Unstable, irregular, wide-complex tachycardias are defibrillated at the manufacturer’s recommended dose for the defibrillator being used. Unstable, regular wide-complex tachycardias are synchronized cardioverted at 100 Joules. Unstable, narrow-comlex regular tachycardias are synchronized cardioverted at 50-100 Joules. Unstable, narrow-complex irregular tachycardias are synchronized cardioverted at 120-200 Joules.