⚠️ The difficulty may be determining if tachycardia is the cause of the problem or secondary to it (e.g. infection, hypovolaemia, drugs like salbutamol). 💡 Most sinus tachycardias are <140/min at rest. Always treat the underlying cause (e.g. pneumonia, LVF, sepsis) and then review in context.

🚑 Initial Tachycardia Management Summary
🔎 Assess for instability ➝ syncope, shock, angina, heart failure/dyspnoea. Stable ➝ follow narrow vs broad QRS pathway. Unstable ➝ sedation + up to 3 × synchronised DC shocks ⚡ + Amiodarone 300 mg IV over 20 mins. Stable, regular narrow: Adenosine 6 mg → 12 mg if needed. Verapamil 5 mg (avoid in WPW or broad QRS). Stable, regular broad: Amiodarone 300 mg IV over 30 mins (assume VT unless proven otherwise). Stable, irregular (AF): Digoxin IV or Amiodarone 300 mg IV over 30 mins.

🚑 Initial Tachycardia Management Summary

🔎 Assess for instability ➝ syncope, shock, angina, heart failure/dyspnoea.
Stable ➝ follow narrow vs broad QRS pathway.
Unstable ➝ sedation + up to 3 × synchronised DC shocks ⚡ + Amiodarone 300 mg IV over 20 mins.
Stable, regular narrow: Adenosine 6 mg → 12 mg if needed. Verapamil 5 mg (avoid in WPW or broad QRS).
Stable, regular broad: Amiodarone 300 mg IV over 30 mins (assume VT unless proven otherwise).
Stable, irregular (AF): Digoxin IV or Amiodarone 300 mg IV over 30 mins.

📖 Introduction

👤 Sinus tachycardia often reflects disease (fever, sepsis, hypovolaemia). Max HR ≈ 220 – age (men), 210 – age (women).
🚨 Unstable signs: syncope, shock, angina, heart failure → urgent action.
✅ Narrow complex tachycardias are usually benign and can often be discharged once treated.
⚡ Wide complex tachycardias (VT until proven otherwise) are dangerous and usually require admission + cardiology review.
📊 Always get a 12-lead ECG during arrhythmia → distinguishes VT from SVT and guides therapy.
💡 Golden rule: assume broad = VT unless incontrovertible proof. DC shock treats both VT & SVT.

🧪 Investigations

FBC, U&E, Troponin, Lipids, Glucose.
12-lead ECG is essential.
If uncertain about broad complex origin ➝ treat as VT.

💊 Management

Stable Narrow Complex SVT: Vagal manoeuvres + IV Adenosine (6–12 mg fast bolus). If fails ➝ Verapamil 5–10 mg slow IV.
Stable AF: Digoxin IV or Amiodarone 300 mg over 60 min, then 900 mg/24 h infusion (central line preferred).
Unstable (VT/AF/SVT): Immediate DC cardioversion ⚡ + sedation. Consider Amiodarone 300 mg load, then infusion. Alternative: Sotalol 2 mg/kg IV over 30 min.
Unstable Broad Complex VT: Lidocaine 100 mg IV bolus ➝ Magnesium sulphate 8 mmol over 10–15 min. May need overdrive pacing.
Torsades de Pointes: IV Magnesium sulphate 8 mmol over 10–15 min ➝ overdrive pacing if refractory.

🇬🇧 Tachycardia Algorithm (UK Resus Council)

🇺🇸 Tachycardia Algorithm (AHA)

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Resuscitation - Adult Tachycardia Algorithm

📖 Introduction

🧪 Investigations

💊 Management

🇬🇧 Tachycardia Algorithm (UK Resus Council)

🇺🇸 Tachycardia Algorithm (AHA)

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