Tachycardia

1
TACHYCARDIA
With Pulses and Poor Perfusion
Assess and support ABCs as needed
Give oxygen
Attach monitor/defibrillator

Symptoms Persist
3 9
Evaluate rhythm 2 Possible
with 12-lead Narrow QRS Evaluate QRS duration Wide QRS Ventricular
(≤0.08 sec) (>0.08 sec)
ECG or monitor Tachycardia

4 5 10
Probable Sinus Tachycardia Probable Supraventricular Tachycardia Synchronized cardioversion:
0.5 to 1 J/kg; if not effective,
Compatible history consistent Compatible history (vague, nonspecific) increase to 2 J/kg
with known cause P waves absent/abnormal Sedate if possible but don’t
P waves present/normal HR not variable delay cardioversion
Variable R-R; constant P-R History of abrupt rate changes
Infants: rate usually <220 bpm May attempt adenosine if it
Infants: rate usually ≥220 bpm
Children: rate usually <180 bpm does not delay electrical
Children: rate usually ≥180 bpm
cardioversion
7
Consider vagal
Maneuvers
(No delays)

8 11
If IV access readily available: Expert consultation advised
Give adenosine 0.1 mg/kg (maximum first Amiodarone 5 mg/kg IV
dose 6 mg) by rapid bolus
6 May double first dose and give once
over 20 to 60 minutes
Search for and treat cause or
(maximum second dose 12 mg)
or Procainamide 15 mg/kg IV
Synchronized cardioversion: 0.5 to 1 J/kg; over 30 to 60 minutes
if not effective, increase to 2 J/kg Do not routinely administer
Sedate if possible but don’t delay amiodarone and procainamide
cardioversion together

During Evaluation Treat possible contributing factors:

Secure, verify airway and vascular Hypovolemia Toxins
access when possible Hypoxia Tamponade, cardiac
Hydrogen ion (acidosis) Tension pneumothorax
Consider expert consultation Hypo-/hyperkalemia Thrombosis (coronary or
Prepare for cardioversion Hypoglycemia pulmonary)
Hypothermia Trauma (hypovolemia)
American Heart Association 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, November 2015, American Heart Association ISBN 978-1- 61669-397- 8, Pages 82
Pediatric Advanced Life Support Provider Manual, American Heart Association, October 2011, ISBN 978-1- 61669-112- 7, pages 135-139

Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020.
If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. Version 2016.02.a

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