Bradycardia & Tachycardia tx

Most recent AHA algorithms here

Any arrhythmia:

  • Assess

    • Airway/breathing

    • Rhythm/blood-pressure/saturation

    • IV access

    • 12-lead (don't delay tx to obtain)

  • Sick or not sick?

    • Hypotension

    • Diaphoretic/pale

    • HF SSX, chest pain

    • New AMS

Bradycardia

  • Give 1 mg atropine

    • Can give a total of 3 doses (3mg) spaced every 3-5 mins

    • Atropine doesn't work in:

      • 2nd ° type II (wide) or 3rd ° (complete) block

  • Or transcutaneous pacing (pads)

  • Or Epinephrine

    • 2-10 µg/kg/min titrated to response

  • Or Dopamine

    • 5-20 µg/kg/min titrated to response

Tachycardia

Stable tachycardia with a pulse

  • Narrow QRS

    • Regular?

      • Try vagal maneuvers

      • Then 6mg adenosine IV push (AC); double the dose to 12mg if it doesn't break

      • β-blockers or CCB

    • Irregular?

      • Diltiazem (Cardizem) 15mg over 2 mins

      • >48hrs ➔ anticoagulation before converting with electricity

  • Wide QRS

    • 150 mg amiodarone infused over 10 minutes, (maintain 1mg/min for 6hrs); can repeat loading dose if it doesn't break

    • or 20-50mg/min procainamide infused til QRS ↓ by half or max dose (17mg/kg)

      • Avoid in prolonged QT or CHF

    • Sotalol 100mg or 1.5mg/kg over 5 minutes

      • Avoid in prolonged QT

  • ANY CHANCE THE ARRHYTHMIA IS ASSOCIATED WITH WPW:

    • 20-50mg/min procainamide infused til QRS ↓ by half or max dose (17mg/kg)

Antiarrhythmics