Broad complex tachycardia (with pulse)

IF ADVERSE SIGNS (systolic BP 90 mmHg, chest pain, heart failure, reduced LOC, rate > 150/min

 

Sedate and cadiovert (synchronized shocks 100J, 200J, 360J)

 

Start Lignocaine +/- Mg2+ and K+

 

 

MgSO4 IV 10ml 50% over 1 hr

 

 

KCI up to 60mmol, max rate 30mmol/hr IV

 

For refractory cases consider Amiodarone, Flecainide, overdrive pacing

If NO adverse signs:

 

GIVE Amiodrone 150mg in 100 mls 5% dextrose over 10 mins OR

 

GIVE Lignocaine 50mg IV over 2 min repeated every 5 min to maximum 200 mg AND start infusion 2mg/min after first bolus OR

 

If K+ known to be low, give KCI and MgSO4 as above

 

If this fails, sedate and give synchronized shocks 100/200/360J

 

If this fails, give Amiodarone 300mg over 5-15 min then 300mg over 1 hr

 

If this fails, repeat synchronized DC shocks as required


Narrow complex tachycardia

Try vagal manoeuvres (EXCEPT atrial fibrillation) then give adenosine 6mg, and repeat if required at 12mg and 12mg again with 2 min intervals

Now treat all narrow complex rhythms the same INCLUDING atrial fibrillation

IF ADVERSE SIGNS (systolic BP 90 mmHg, chest pain, heart failure, reduced level of response, rate >150/min):

 

Sedate and cardiovert (synchronized shocks 100J, 200J, 360J)

 

If this fails give Amiodarone 300mg over 5-15 min then 300mg over 1 hr

 

If this fails, repeat synchronized DC shocks as required

If NO adverse signs choose from:

 

Esmolol (see product literature)

 

Digoxin: max dose 500mcg over 30 min x 2

 

Verapamil 5-10 mg IV (DO NOT give Esmolol after Verapamil)

 

Amiodarone 300 mg over 1 hr

 

Overdrive pacing (NOT atrial fibrillation)


Reproduced from Resuscitaion Council (UK) Guidelines (2000)
Further information can be found by clicking on these links:
Broad Complex Tachycardia     Narrow Complex Tachycardia

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