EKG

Tachycardia

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Tachycardia, Unstable Tachycardia, Unstable Tachyarrhythmia

  • Signs
  • Unstable
  • Differential Diagnosis
  1. Pulseless Electrical Activity
  2. Narrow Complex Tachycardia
    1. Sinus Tachycardia
    2. Irregular Supraventicular Tachycardia
      1. Atrial Fibrillation
    3. Regular Supraventricular Tachycardia
      1. Sinus Tachycardia (rarely >150 in adults)
      2. Paroxysmal Supraventricular Tachycardia (PSVT)
      3. Atrial Flutter
        1. Atrial rate: 300 bpm
        2. Ventricular rate most commonly 2:1 = 150 bpm
  3. Wide Complex Tachycardia
    1. Ventricular Tachycardia
    2. Supraventricular Tachycardia with aberrancy
    3. Torsade De Pointes
  • Management (Same initial approach for all ages)
  1. ABC Management
  2. Mnemonic: IV-O2-Monitor
    1. Obtain IV Access
    2. Oxygen Delivery
    3. Cardiopulmonary monitor
  3. Additional evaluation
    1. Vital Signs
    2. History
    3. Exam
    4. Electrocardiogram
    5. Chest XRay
  4. If signs of immediate failure present:
    1. Pulse Present and NOT Sinus Tachycardia
      1. Prepare for immediate Synchronized Cardioversion
      2. Brief trial of medications (e.g. Adenosine) if no delay
    2. Pulse Absent
      1. Asystole
      2. Pulseless Electrical Activity
      3. Ventricular Tachycardia
      4. Ventricular Fibrillation
  5. Assess QRS Duration
    1. If QRS Duration narrow (<0.09 sec in children or <0.12 sec in adults)
      1. See Narrow Complex Tachycardia
      2. See Supraventricular Tachycardia Management in the Child
      3. See Supraventricular Tachycardia Management in the Adult
    2. If QRS Duration wide (>0.09 sec in children or >0.12 sec in adults)
      1. See Wide Complex Tachycardia
      2. See Ventricular Tachycardia Management in the Adult
      3. See Ventricular Tachycardia Management in the Child