Adults

Tachycardia - Unstable

Diagnosis

Persistent tachycardia with hypotension, ischemic chest pain, altered mental status, or shock

Diagnosis

Persistent tachycardia with hypotension, ischemic chest pain, altered mental status, or shock

  1. Call for help and a code cart

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Turn FiO2 to 100% and turn down volatile anesthetic

  3. Analyze rhythm

    • 6 mg rapid IV push
    • If persistent, 12 mg rapid IV push
    • Caution in severe asthma

  4. Prepare for immediate synchronized cardioversion

    • Sedate conscious patients unless deteriorating rapidly

  5. Cardiovert per instructions in gray box

    • If cardioversion needed and unable to synchronize, use high-energy unsynchronized shocks (biphasic - select highest setting, monophasic - 360 J)

  6. If resistant to electrical conversion, consider amiodarone

    • 150 mg IV over 10 minutes
    • May repeat x1

  7. Consider cardiology consultation

Critical CHANGES

If Cardiac Arrest develops:

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.