Resuscitation Council (UK)

• Support ABCs: give oxygen; cannulate a vein

• Monitor ECG, BP, SpO2
Adult tachycardia algorithm • Record 12-lead ECG if possible; if not, record rhythm strip
(with pulse) • Identify and treat reversible causes (e.g. electrolyte abnormalities)

Synchronised DC Shock * Unstable

Is patient stable?
Up to 3 attempts
Signs of instability include:
1. Reduced conscious level 2. Chest pain
3. Systolic BP < 90 mmHg 4. Heart failure
• Amiodarone 300 mg IV over 10-20 min (Rate-related symptoms uncommon at less than 150 beats min-1)
and repeat shock; followed by:
• Amiodarone 900 mg over 24 h Stable

Is QRS narrow (< 0.12 sec)?

Broad Narrow

Broad QRS Narrow QRS

Is QRS regular? Is rhythm regular?
Regular Irregular
Irregular Regular • Use vagal manoeuvres Irregular Narrow Complex
• Adenosine 6 mg rapid IV bolus; Tachycardia
Seek expert help if unsuccessful give 12 mg;
Probable atrial fibrillation
if unsuccessful give further 12 mg.
Control rate with:
• Monitor ECG continuously
Possibilities include: If Ventricular Tachycardia • β-Blocker IV or digoxin IV
• AF with bundle branch block (or uncertain rhythm): If onset < 48 h consider:
treat as for narrow complex • Amiodarone 300 mg IV • Amiodarone 300 mg IV 20-60 min;
• Pre-excited AF over 20-60 min; Normal sinus rhythm restored? then 900 mg over 24 h
consider amiodarone then 900 mg over 24 h
• Polymorphic VT (e.g.
torsade de pointes - give
If previously confirmed SVT Yes No
with bundle branch block:
magnesium 2 g over 10 min)
• Give adenosine as for regular Probable re-entry PSVT:
narrow complex tachycardia Seek expert help
* Attempted electrical cardioversion is
• Record 12-lead ECG in sinus
always undertaken under sedation
rhythm
or general anaesthesia • If recurs, give adenosine again &
consider choice of anti-arrhythmic Possible atrial flutter
prophylaxis • Control rate (e.g. β-Blocker)