Supraventricular Tachycardia, Stable

 

(Maintaining adequate mentation, blood pressure, respiratory status, & absence of chest pain)

Narrow complex, rate over 150, regular with no P waves or signs of A-fib or flutter

 

Assess and maintain ABCs

Administer O2

Assess vitals

Apply monitors

(EKG, Pulse Ox, B/P)

Review history

        Physical Exam

Atrial fib/flutter?                                          Establish IV access

See AF algorithm

    Consider Ordering:

(12 lead ECG, Cardiac enzymes, CXR)

(Expert cardiology consult)

    

 

Vagal Maneuvers

 

 

Adenosine 6 mg IVP rapidly followed by flush

Adenosine 12 mg IVP rapidly followed by flush

May repeat Adenosine 12 mg x 1

 

If rhythm fails convert followed by:

Choose 1

 

Calcium Channel Blocker

Diltiazem 15-20 mg may repeat 20-25 mg in 15 min

                       Verapamil 2.5-5.0 mg may repeat 5-10 mg in 15-30 min

OR

Beta Blocker

Atenolol 5 mg over 5 min may repeat in 10 min

Metoprolol 5 mg over 5 min may repeat Q5 x 2

 

 

If rhythm still fails to convert

 

          May choose sedation and elective Cardioversion or other medications

based on a more definitive rhythm diagnosis.

 

 

 

Supraventricular Tachycardia Unstable

  

 

(Rate over 150 with decreased LOC, hypotension, pulmonary edema, or chest pain)

 

Assess and maintain ABCs

Administer O2

Assess vitals

Apply monitors

 

 

 

(EKG, Pulse Ox, B/P)

                                                  Brief History

IV/IO access

(do not delay cardioversion)

 

 

Immediate Management

 

Sedation

(if conscious and B/P allows)

 

 

Synchronized Cardioversion

100j, 200j, 300j, 360j

(or biphasic equivalent usually 120-200j)

 

If unsuccessful:

medication sequence for stable