ALCS Algorithms

Tachycardia With A Pulse Algorithm

Algorithm Notes

Management of Persistent Tachyarrhythmias

This algorithm outlines a structured approach for assessing and managing patients presenting with persistent tachyarrhythmias, a condition where the heart rate is typically ≥ 150/min. The approach is designed to rapidly identify life-threatening conditions associated with tachyarrhythmias and to implement appropriate interventions.

Initial Assessment and Stabilization

Maintain Patent Airway: Ensure that the patient’s airway is open and assist breathing as necessary.

Oxygen Administration: Provide oxygen if the patient is hypoxemic to maintain adequate oxygen saturation.

Cardiac Monitoring: Attach the patient to a cardiac monitor to identify the rhythm, continuously monitor blood pressure, and check oximetry.

Identify and Treat Underlying Causes

Assess Symptoms and Stability: Determine if the tachyarrhythmia is causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure.

IV Access and 12-Lead ECG: Establish IV access and perform a 12-lead ECG if available to further assess the cardiac rhythm and underlying causes.

Specific Treatment Based on QRS Duration

Narrow QRS Complex (<0.12 seconds):

Vagal Maneuvers: Attempt vagal maneuvers to decrease heart rate.
Adenosine: If the rhythm is regular, administer a rapid IV push of adenosine (6 mg followed by a saline flush, and if needed, a second dose of 12 mg).
Beta-Blockers or Calcium Channel Blockers: Consider these medications to control heart rate and rhythm.
Synchronized Cardioversion: Consider if the rhythm is regular and adenosine is ineffective. Start with a dose of 50-100 joules for narrow regular rhythms.

Wide QRS Complex (≥0.12 seconds):

Antiarrhythmic Infusion: If the tachycardia is monomorphic and regular, consider administering antiarrhythmics such as procainamide, amiodarone, or sotalol.

Procainamide: Administer at a rate of 20-50 mg/min until the arrhythmia is suppressed, hypotension occurs, QRS duration increases by more than 50%, or a maximum dose of 17 mg/kg is reached.
Amiodarone: Give 150 mg over 10 minutes, repeat as needed if ventricular tachycardia (VT) recurs. Follow with a maintenance infusion of 1 mg/min for the first 6 hours.
Sotalol: Administer 100 mg (1.5 mg/kg) over 5 minutes, avoiding if there is a prolonged QT interval.

Synchronized Cardioversion: For wide regular tachycardias, start with 100 joules. For irregular wide complexes, use a defibrillation dose (not synchronized).

Expert Consultation and Continued Monitoring

Consider Expert Consultation: Always consider consulting a cardiology specialist when managing complex cases or when initial treatments fail.

Continuous Monitoring: Monitor the patient’s response to treatment and adjust therapies based on clinical response and ongoing monitoring data.

BG Gradient ProMed

Simple, affordable pricing

Select your Online ACLS, PALS, BLS, or CPR Medical Certification Course below

ACLS - ProMed

The Advanced Cardiac Life Support (ACLS) is an accredited online medical certification course that teaches medical professionals to respond to nearly all cardiopulmonary emergencies.

PALS - ProMed

The Pediatric Advanced Life Support (PALS) Recertification instructs medical professionals on performing pediatric cardiopulmonary resuscitation in emergencies.

BLS - ProMed

The Basic Life Support (BLS) Recertification is intended to teach healthcare professionals the basic steps of CPR and rescue breathing for adults, children, and infants.

CPR - ProMed

Our online medical certification course for CPR, Automated External Defibrillator (AED), and First Aid is designed to teach adult, child, and infant CPR and AED use. It also demonstrates ways to relieve choking in adults, children, and infants.