Adult tachycardia

Assess with Life threatening Synchronised DC

YES
ABCDE approach features? shock
• Give oxygen if SpO2 < 94% up to 3 attempts
1. Shock
• Obtain IV access • Sedation or anaesthesia if
• Monitor ECG, BP, SpO2, 2. Syncope conscious
record 12-lead ECG 3. Myocardial If unsuccessful:
• Identify and treat reversible causes ischaemia • Amiodarone 300 mg IV
e.g. electrolyte abnormalities, over 10–20 min
hypovolaemia causing sinus 4. Severe heart
• Repeat synchronised DC
tachycardia failure shock

UNSTABLE

STABLE
Seek expert help
NO

Is the QRS narrow (< 0.12 s)?

BROAD QRS NARROW QRS

Is QRS regular? Is QRS regular?

IRREGULAR REGULAR REGULAR IRREGULAR

Possibilities If VT (or uncertain Vagal Probable atrial

include:
• Atrial fibrillation with
bundle branch block
treat as for irregular
narrow complex
• Polymorphic VT
(e.g. torsades de pointes)
give magnesium 2 g
over 10 min
rhythm): manoeuvres fibrillation:
• Amiodarone 300 mg IV • Control rate with
over 10–60 min beta-blocker
If ineffective: • Consider digoxin or
If previous certain
diagnosis of SVT with • Give Adenosine amiodarone if evidence
bundle branch block/ (if no pre-excitation) of heart failure
aberrant conduction: – 6 mg rapid IV bolus • Anticoagulate if
duration > 48 h
• Treat as for regular – If unsuccessful,
narrow complex give 12 mg
tachycardia – If unsuccessful,
give 18 mg
• Monitor ECG
continuously

If ineffective:
• Verapamil
or beta-blocker

If ineffective:
• Synchronised DC shock up to 3 attempts
• Sedation or anaesthesia if conscious