Heart Rate Fast = tachycardia rate > 150 bpm.Technically any HR > 100 is tachycardia. And just like the bradycardia algorithm, when we see symptoms in patients is different than the technical definition. Most patients will show signs of poor perfusion with a HR > 150 bpm. Be aware that any heart rate > 90 bpm meets one of the SIRS criteria (Systemic Inflammatory Response Syndrome), AND finding the cause of the increase heart rate is very important.(Treat the patient, not the monitor).
Identify and treat underlying cause:
Maintain patent airway
Oxygen if hypoxemic
Cardiac monitor to identify rhythm
Monitor BP and O2 sats
-Consider causes (Differential Diagnosis-see PEA for Hs and Ts for
If yes to any of these, then the patient is considered unstable. It doesn't matter whether it is wide or narrow complex tachycardia, prepare for immediate cardioversion (hit the sync button on the defibrillator). This will allow the defibrillator to synchronize with the pt's QRS complex so as not to shock during the vulnerable repolarization phase (on the T-wave). This is known as synchronized cardioversion.
1. Monitor O2 saturation
2. Prepare suction device
3. Make sure intubation equipment is available
4. Make sure IV line is patent
5. Premedicate whenever possible: Midazolam or
for sedation with an analgesic unless patient is
Note: I'm calling the machine that does this procedure a defibrillator. The difference between cardioversion and defibrillation is that the sync button is on for cardioversion and off for defibrillation. The machine will still be called a defibrillator, but defibrillation and cardioversion are different procedures as described.