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ACLS Algorithms (aclsalg.htm) /  ACLS Tachycardia Algorithm for Managing Stable Tachycardia

ACLS Tachycardia Algorithm  (https://www.facebook.com/aclstrainingcenter)  (https://twitter.com/aclstraining)

for Managing Stable Tachycardia

Apr 27, 2018

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 (mailto:support@acls.net?
subject=ACLS%20tachycardia%20algorithm%20for%20managing%20stable%20tachycardia%20algorithm&body=I%20had%20a%20question%20about%20your%20ACLS%20Ta
for an updated document.

Using the ACLS Tachycardia Algorithm for Managing

Stable Tachycardia PDF version
The key to managing a patient with any tachycardia is to check if pulses are present, decide if the patient is stable or
unstable, and then treat the patient based on the patient's condition and rhythm. If the patient does not have a pulse,
follow the ACLS Pulseless Arrest Algorithm. If the patient has a pulse, manage the patient using the ACLS Tachycardia
Algorithm.

Definition of stable tachycardia

For a diagnosis of stable tachycardia, the patient meets the following criteria:

The patient's heart rate is greater than 100 bpm.

The patient does not have any serious signs or symptoms as a result of the increased heart rate.
 Print PDF (images/algo-tachycardia.pdf)

Overview
Find out if significant symptoms are present. Evaluate the symptoms and decide if they are caused by the tachycardia
Order the full set of
or other systemic conditions. Use these questions to guide your assessment:
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Does the patient have symptoms?
Is the tachycardia causing the symptoms?  Order now $40 (images/buy_products.htm)
Is the patient stable or unstable?
Is the QRS complex narrow or wide?
Is the rhythm regular or irregular?
Is the rhythm sinus tachycardia?

Guidelines
Situation Assessment and Actions

Patient has significant signs or symptoms of The tachycardia is unstable.

tachycardia AND they are being caused by Immediate cardioversion is indicated.
the arrhythmia.

Patient has a pulseless ventricular Follow the Pulseless Arrest Algorithm.

tachycardia. Deliver unsynchronized high-energy
shocks.

Patient has polymorphic ventricular Treat the rhythm as ventricular

tachycardia AND the patient is unstable. fibrillation. Deliver unsynchronized
high-energy shocks.
Steps for Managing Stable Tachycardia
Does the patient have a pulse?

Yes, the patient has a pulse. Complete the following:

1. Assess the patient using the primary and secondary surveys.

2. Check the airway, breathing, and circulation

3. Give oxygen and monitor oxygen saturation.
4. Get an ECG.
5. Identify rhythm.
6. Check blood pressure.
7. Identify and treat reversible causes.

Is the patient stable?

Look for altered mental status, ongoing chest pain, hypotension, or other signs of shock.

Remember: Rate-related symptoms are uncommon if heart rate is < 150 bpm.

Yes, the patient is stable. Take the following actions:

1. Start an IV.
2. Obtain a 12-lead ECG or rhythm strip.

Is the QRS complex wide or narrow?

Patient Treatment

The patient's QRS Try vagal maneuvers. Give adenosine 6 mg rapid IV push. If
is narrow and patient does not convert, give adenosine 12 mg rapid IV push.
rhythm is regular. May repeat 12 mg dose of adenosine once.

Does the patient's rhythm convert? If it does, it was probably reentry supraventricular tachycardia. At this point you watch for a recurrence. If the tachycardia resumes, treat
with adenosine or longer-acting AV nodal blocking agents, such as diltiazem or beta-blockers.

Patient Treatment

The patient's Consider an expert consultation.

QRS is narrow (<
0.12 sec).

The patient's Control patient's rate with diltiazem or beta-blockers. Use beta-
rhythm is blockers with caution for patients with pulmonary disease or
irregular. congestive heart failure.

If the rhythm pattern is irregular narrow-complex tachycardia, it is probably atrial fibrillation, possible atrial flutter, or multi-focal atrial tachycardia.

Patient Treatment

Patient's rhythm has wide (> Expert consultation is advised.

0.12 sec) QRS complex AND
Patient's rhythm is regular.

Patient is in ventricular Amiodarone 150 mg IV over 10 min; repeat as

tachycardia or uncertain needed to maximum dose of 2.2 g in 24 hours.
rhythm. Prepare for elective synchronized cardioversion.

Patient is in supraventricular Adenosine 6 mg rapid IV push If no conversion, give

tachycardia with aberrancy. adenosine 12 mg rapid IV push; may repeat 12 mg
dose once.

Patient's rhythm has wide (> Seek expert consultation.

0.12) QRS complex AND
Patient's rhythm is irregular.

If pre-excited atrial fibrillation Avoid AV nodal blocking agents such as adenosine,

(Atrial fibrillation in Wolff- digoxin, diltiazem, verapamil. Consider amiodarone
Parkinson-White Syndrome) 150 mg IV over 10 min.
 Patient has recurrent Seek expert consultation,
polymorphic VT

If patient has torsades de Give magnesium (load with 1-2 g over 5-60 min; then
pointes rhythm on ECG infuse.

Caution: If the tachycardia has a wide-complex QRS and is stable, consult with an expert. Management and treatment for a stable tachycardia with a wide QRS complex and
either a regular or irregular rhythm should be done in the hospital setting with expert consultation available. Management requires advanced knowledge of ECG and rhythm
interpretation and anti-arrhythmic therapy.

Considerations:
You may not be able to distinguish between a supraventricular wide-complex rhythm and a ventricular wide-complex rhythm. Most wide-complex tachycardias originate
in the ventricles.
If the patient becomes unstable, proceed immediately to treatment. Do not delay while you try to analyze the rhythm.
If the patient becomes unstable, proceed immediately to treatment. Do not delay while you try to analyze the rhythm.

Using the ACLS Tachycardia Algorithm for Managing Stable Tachycardia

The key to managing a patient with any tachycardia is to check if pulses are present, decide if the patient is stable or unstable, and then treat the patient based on the patient's
condition and rhythm. If the patient does not have a pulse, follow the ACLS Pulseless Arrest Algorithm. If the patient has a pulse, manage the patient using the ACLS
Tachycardia Algorithm.

Definition of stable tachycardia

For a diagnosis of stable tachycardia, the patient meets the following criteria:

The patient's heart rate is greater than 100 bpm.

The patient does not have any serious signs or symptoms as a result of the increased heart rate.
The patient has an underlying cardiac electrical abnormality that is generating the arrhythmia.

Overview
Find out if significant symptoms are present. Evaluate the symptoms and decide if they are caused by the tachycardia or other systemic conditions. Use these questions to
guide your assessment:

Does the patient have symptoms?

Is the tachycardia causing the symptoms?
Is the patient stable or unstable?
Is the QRS complex narrow or wide?
Is the rhythm regular or irregular?
Is the rhythm sinus tachycardia?

Guidelines
Situation Assessment and Actions

Patient has significant signs or symptoms of The tachycardia is unstable.

tachycardia AND they are being caused by Immediate cardioversion is indicated.
the arrhythmia.

Patient has a pulseless ventricular Follow the Pulseless Arrest Algorithm.

tachycardia. Deliver unsynchronized high-energy
shocks.

Patient has polymorphic ventricular Treat the rhythm as ventricular

tachycardia AND the patient is unstable. fibrillation. Deliver unsynchronized
high-energy shocks.

Steps for Managing Stable Tachycardia

Does the patient have a pulse?
Yes, the patient has a pulse. Complete the following:

1. Assess the patient using the primary and secondary surveys.

2. Check the airway, breathing, and circulation
3. Give oxygen and monitor oxygen saturation.
4. Get an ECG.
5. Identify rhythm.
6. Check blood pressure.
7. Identify and treat reversible causes.
Is the patient stable?
Look for altered mental status, ongoing chest pain, hypotension, or other signs of shock.

Remember: Rate-related symptoms are uncommon if heart rate is < 150 bpm.

Yes, the patient is stable. Take the following actions:

1. Start an IV.
2. Obtain a 12-lead ECG or rhythm strip.

Is the QRS complex wide or narrow?

Patient Treatment

The patient's QRS Try vagal maneuvers. Give adenosine 6 mg rapid IV push. If
is narrow and patient does not convert, give adenosine 12 mg rapid IV push.
rhythm is regular. May repeat 12 mg dose of adenosine once.

Does the patient's rhythm convert? If it does, it was probably reentry supraventricular tachycardia. At this point you watch for a recurrence. If the tachycardia resumes, treat
with adenosine or longer-acting AV nodal blocking agents, such as diltiazem or beta-blockers.

Patient Treatment

The patient's Consider an expert consultation.

QRS is narrow (<
0.12 sec).

The patient's Control patient's rate with diltiazem or beta-blockers. Use beta-
rhythm is blockers with caution for patients with pulmonary disease or
irregular. congestive heart failure.

If the rhythm pattern is irregular narrow-complex tachycardia, it is probably atrial fibrillation, possible atrial flutter, or multi-focal atrial tachycardia.

Patient Treatment

Patient's rhythm has wide (> Expert consultation is advised.

0.12 sec) QRS complex AND
Patient's rhythm is regular.

Patient is in ventricular Amiodarone 150 mg IV over 10 min; repeat as

tachycardia or uncertain needed to maximum dose of 2.2 g in 24 hours.
rhythm. Prepare for elective synchronized cardioversion.

Patient is in supraventricular Adenosine 6 mg rapid IV push If no conversion, give

tachycardia with aberrancy. adenosine 12 mg rapid IV push; may repeat 12 mg
dose once.

Patient's rhythm has wide (> Seek expert consultation.

0.12) QRS complex AND
Patient's rhythm is irregular.

If pre-excited atrial fibrillation Avoid AV nodal blocking agents such as adenosine,

(Atrial Fibrillation in Wolff- digoxin, diltiazem, verapamil. Consider amiodarone
Parkinson-White Syndrome) 150 mg IV over 10 min.

Patient has recurrent Seek expert consultation,

polymorphic VT

If patient has torsades de Give magnesium (load with 1-2 g over 5-60 min; then
pointes rhythm on ECG infuse.

Caution: If the tachycardia has a wide-complex QRS and is stable, consult with an expert. Management and treatment for a stable tachycardia with a wide QRS complex and
either a regular or irregular rhythm should be done in the hospital setting with expert consultation available. Management requires advanced knowledge of ECG and rhythm
interpretation and anti-arrhythmic therapy.

Considerations:
You may not be able to distinguish between a supraventricular wide-complex rhythm and a ventricular wide-complex rhythm. Most wide-complex tachycardias originate
in the ventricles.
If the patient becomes unstable, proceed immediately to treatment. Do not delay while you try to analyze the rhythm.

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