Identify and treat underlying cause:
- Cardiac monitor to identify rhythm
-Consider causes (Differential Diagnosis-see PEA for Hs and Ts for
some possibilities and treatments)
Ask these questions, does the patient have:
1. Hypotension? (decreased blood pressure SBP < 90
2. Altered mental status?
3. Signs of shock?
4. Ischemic chest discomfort?
5. Acute heart failure?
If the answer is NO to all of the these:
Assess Rapid Heart Rate as Narrow or Wide Complex Tachycardia?
Yes - QRS complex > 0.12 - Wide
VT or VF
- Pre-excited tachycardias (associated with or mediated by an accessory pathway)
- Ventricular paced rhythms
Is the rhythm regular or irregular?
- If regular and monomorphic, then treatment:
If rhythm is irregular then treatment:
*Amiodarone 150 mg bolus over 10 min, then 1 mg/min for 6 hours, then
0.5 mg/min to maximum dose of 2.2 grams in 24 hours.
*Procainamide 20-50 mg/min, then hang a drip at 1-4 mg/min - Can
prolong the QT interval - Do not give to patients with a prolonged QT
*Sotalol 100 mg IV over 5 minutes - Can prolong the QT interval - Do
NOT give to patients with a prolonged QT interval.