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Tachycardia Algorithm Review Romulo B. Babasa III, MD

Tachycardia Algorithm Review Romulo B. Babasa III, MD. 1. Case Scenario.

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Tachycardia Algorithm Review Romulo B. Babasa III, MD

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  1. Tachycardia Algorithm Review Romulo B. Babasa III, MD 1

  2. Case Scenario An 34-year-old came into the ER complaining of chest tightness and palpitations, which roused her from sleep. She had cold, clammy skin and pallor. Vital signs were HR = 154 bpm; BP =100/70 mm Hg; RR = 24 rpm. Full and equal pulses. Rhythm: see next slide.

  3. 34-Year-Old Woman:Tachycardia • Identify A, B, and C • Which one is most likely to be her rhythm? A B C

  4. Rhythms to Learn • Sinus tachycardia • Narrow QRS • Regular • Supraventricular tachycardia (SVT) • Junctional tachycardia • Ectopic atrial tachycardia • Wolff-Parkinson-White (WPW) • Irregular • Atrial fibrillation • Atrial flutter

  5. Rhythms to Learn • Wide QRS • Regular • Ventricular Tachycardia • Irregular • Torsades de Pointes

  6. Sinus Tachycardia

  7. Supraventricular Tachycardia

  8. Paroxysmal SVT

  9. Junctional Tachycardia

  10. Atrial Tachycardia

  11. WPW Syndrome

  12. Atrial Fibrillation

  13. Atrial Flutter

  14. Ventricular Tachycardia

  15. Ventricular Tachycardia

  16. Torsades de Pointes

  17. Tachycardia Algorithm (1 of 2)

  18. Synchronized Cardioversion • The purpose of cardioversion is to deliver a precisely timed electrical current to the heart to convert an organized rhythm to a more hemodynamically stable rhythm • Supraventricular tachycardia, atrial flutter, atrial fibrillation, and WPW syndrome

  19. Defibrillation • The purpose of defibrillation is to deliver a randomly timedigh-energy electrical current to the heart that is fibrillating to restore a normal sinus rhythm • Ventricular tachycardia, ventricular fibrillation

  20. Tachycardia Algorithm (1 of 2)

  21. Tachycardia Algorithm (2 of 2)

  22. Narrow QRS Tachycardia

  23. VagalManeuvres These maneuvres increase the vagal tone that have been shown to slow conduction and prolong the refractory period in the AV node: • Carotid sinus massage – exert pressure on the carotid sinus and baroreceptors against the transverse process of C6 • Valsalva maneuvre

  24. Adenosine • Endogenous nucleoside produced by the degradation of adenosine triphosphate (ATP) • Slows cardiac conduction and restores sinus rhythm by transient AV nodal block • Rapidly metabolized by most cells • Very short half-life (<10 seconds)

  25. Adenosine • Onset of action: 20-30 seconds • Duration of action: 60-90 seconds • Indication: - for emergency treatment of SVT (supraventricular tachycardia)

  26. Adenosine • Dosage: - initial dose of 6mg rapid IV bolus (1-2 sec) - may be repeated 2x with 12mg after 1-2 mins - followed immediately by a 10-20ml fluid flush - elevate the arm to maximize distribution - if infused slowly, can cause systemic vasodilation and a reflexive tachycardia

  27. Adenosine • Pediatric dose: 0.1-0.2 mg/kg • Possible adverse effects: - well tolerated because they last <1minute - most common: - dyspnea, vertigo, headache, numbness - facial flushing, chest pain, palpitation

  28. Narrow QRS Tachycardia

  29. Wide QRS Tachycardia

  30. Amiodarone • Antiarrhythmic agent (Class III) • Delays repolarization by prolonging the action potential duration and effective refractory period. • Amiodarone slows the heart by impairing SA nodal function, depressing AV nodal conduction, modifying the automaticity of spontaneously firing fibers in the Purkinje system, and prolonging the refractory period in an accessory pathway (e.g., WPW syndrome).

  31. Amiodarone • Dosage: - VF/pulseless VT: 300mg IV bolus may be repeated with 150mg - other dysrhythmias: 150mg IV in 100ml D5W x 10 minutes infusion: 1 mg/min for 6 hours 0.5 mg/min thereafter - Pediatric dose: 5mg/kg over 20-60 minutes

  32. THANK YOU Good luck sa‘tin lahat!

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