Tachyarrhythmia - Management of ( Adult Critical Care )
|Publication: 20/12/2016 --|
|Last review: 04/12/2019|
|Next review: 04/12/2022|
|Standard Operating Procedure|
|Approved By: ACC Clinical Governance|
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
Management of Tachyarrhythmia
- Is this a primary cardiac problem?
- Remember fast AF may reflect hypovolaemia not inadequate rate control
- Is the patient compromised?
- e.g significant escalation in vasopressors, hypotension, cardiac failure or ischaemia
- If yes then synchronised DC cardioversion
- Do you need to initiate ALS?
- Broad or narrow complex?
- Regular or irregular?
- Is there a correctable precipitating cause?
- e.g CVC in too far, electrolyte abnormality, prolonged QTc
- Vagal maneuvers
- Adenosine 6mg, 12mg, 12mg
- If SR not restored consider B blockers (e.g. metoprolol)
- Atrial flutter treat as per AF
- New AF or A.flutter with variable block
- Magnesium 5g over 1hr
- If no response amiodarone 300mg over 20-60 mins
- Consider follow up 900mg amiodarone 24hr infusion
- If no/inadequate response consider digoxin or B blockers
- If unclear rhythm then short acting B blockers may reveal underlying pathology
- Amiodarone 300mg over 20 – 60 mins
- Beware pre-existing bundle branch block and SVT
- AF with bundle branch block – treat as for AF
- Polymorphic VT – Torsades de pointes – Magnesium 2g over 10 mins
AF in Wolf Parkinson White
- Avoid adenosine, B blockers, Ca channel blockers. Amiodarone may be unsafe also.
- DC cardioversion, procainamide, ibutilide may be options – suggest d/w cardiology/ICU.
Patients in Adult Critical Care
|Target patient group:||Patients in Adult Critical Care|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
ACC Clinical Governance
LHP version 1.0
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