Tachycardia Algorithm - ICU Advantage Lecture

Introduction

• Presenter: Eddie Watson
• Goal: Provide confidence in ICU care by simplifying critical care subjects.
• Encourage subscribing to ICU Advantage for more content.

Tachycardia Overview

• Tachycardia: Rapid heart rate > 100 beats per minute.
• Faster heart rates can reduce the heart's filling time, leading to decreased preload and cardiac output.
• Can result in decreased perfusion and unstable tachycardia.

Important Rhythms in Unstable Tachycardia

• Sinus Tachycardia
• Atrial Fibrillation (AFib)
• Atrial Flutter (AFlutter)
• Reentry Supraventricular Tachycardia (SVT)
• Monomorphic Ventricular Tachycardia (V-Tach)
• Polymorphic V-Tach
• Wide Complex Tachycardia

Initial Assessment

• Determine if symptoms are caused by tachycardia.
• Important when heart rate > 150 bpm.
• Assess and treat underlying causes while maintaining airway, breathing, and provide oxygen.
• Monitor ECG, blood pressure, and pulse oximetry.

Signs and Symptoms of Decreased Perfusion

• Chest pain
• Signs of shock
• Difficulty breathing
• Altered level of consciousness
• Weakness, fatigue
• Syncope
• Acute heart failure

Treatment of Unstable Tachycardia

• Synchronized Cardioversion
  • Similar to defibrillation, synchronized with QRS complex to avoid T-wave shock.
  • Consider sedation if blood pressure supports it.
• Adenosine for Narrow and Regular QRS
  • 6 mg rapid IV push, followed by two 12 mg doses if necessary.
  • Use three-way stopcock for quick administration.

Assessment of Stable Tachycardia

• Determine if QRS complex is wide (> 0.12 seconds) or narrow.
• Wide QRS Treatment
  • Ensure IV access, get 12-lead ECG.
  • Consider adenosine for regular monomorphic rhythms.
  • Use antiarrhythmic medications: Amiodarone, Procainamide, Sotalol.
  • Magnesium for polymorphic V-Tach.
  • Consult cardiologist.
• Narrow QRS Treatment
  • Ensure IV access, get 12-lead ECG.
  • Consider vagal maneuvers (bearing down, blowing through straw, carotid massage).
  • Use adenosine for regular rhythms.
  • Consider beta blockers and calcium channel blockers.
  • Consult cardiologist.

Key Questions for Assessment and Management

• Are symptoms present?
• Is patient stable or unstable?
• Is QRS complex narrow or wide?
• Is rhythm regular or irregular?
• Is QRS monomorphic or polymorphic?

Conclusion

• Review of AHA recommendations on tachycardia and ACLS algorithm.
• Call to action to like, comment, share, and subscribe to the channel.
• Acknowledgment and appreciation for YouTube and Patreon supporters.
• Explore further support options and upcoming lessons.