all right you guys welcome back to another video lesson from icu advantage my name is eddie watson and my goal with this channel is to try and give you guys the confidence to succeed in the icu by making these critical care subjects easy to understand i hope that i'm able to do just that for you guys and if you'd be interested in getting more content such as this video here then i do invite you to subscribe to the channel below make sure you hit that bell icon and select all notifications so you never miss out when i release a new lesson all right so in this lesson we move on to tackle the next american heart association acls algorithm that we're going to talk about the tachycardia algorithm now just as with our bradycardia arrhythmias are tachyarrhythmias can also lead our patients into a state in which they have decreased perfusion which if left unchecked can continue to deteriorate into cardiac arrest once again thanks to the the work and the recommendations of the aha we have a simplified approach to managing patients in this emergency situation this can help to allow us to ensure timely and proper treatment for our patients and so we'll discuss this tachycardia algorithm now [Music] all right so tachycardia is a rapid heart rate which is greater than 100 beats per minute from there the faster that a patient's heart rate gets the less time that they're going to have for filling between each beat which can decrease our patient's preload and then ultimately reduce their cardiac output this reduction in cardiac output can lead to decreased perfusion and can lead to unstable tachycardia now just like with the other algorithms it's going to be important for you to be able to identify the potential rhythms associated with unstable tachycardia and those rhythms are sinus tachycardia atrial fibrillation or afib atrial flutter or a flutter reentry supraventricular tachycardia or svt monomorphic vtec polymorphic vtac and wide complex tachycardia again i'm going to link to a series going over all of this and everything else related to ecg rhythm interpretation up above so make sure and watch that if you do need a refresher but when beginning this algorithm the very first thing we need to ask is if our patient's symptoms are being caused by the tachycardia and if so then we need to treat the tachycardia and so we need to assess the necessity and the appropriateness for treating their tachycardia now typically we're gonna see this when our patient's heart rate is greater than 150. now from here our priority should be to assess for and really treat any underlying causes while we're also maintaining the patient's airway and assisting their breathing if necessary providing oxygen to them if they are hypoxic and then monitoring their ecg blood pressure and pulse oximetry from there if the patient's tachycardia is persisting then we need to ask if it's causing symptoms of decreased perfusion if it is then we need to act those signs and symptoms are going to include things like chest pain signs of shock difficulty breathing altered level of consciousness weakness fatigue syncope and acute heart failure and so if we are seeing any of these signs and symptoms in our patient then the primary response to unstable tachycardia should be synchronized cardioversion so this is going to be very similar to defibrillation except depending on the rhythm that they have that this may use lower energy and then more importantly we're going to be synchronizing to the patient's qrs complex the purpose of this is to not land the shock on the patient's t-wave which can lead to lethal arrhythmias now i do discuss this in more detail in my lesson where i talk about the defibrillator so again i'll link to that lesson up above here but also remember too that we do want to consider sedation if our patients are able to tolerate it unfortunately oftentimes at least initially that if they're unstable that they're not going to have an adequate blood pressure to really support adding a sedative so please do keep this in mind that this is quite painful for the patient that said if the patient does have a narrow and regular qrs complex think svt here then we can consider giving a medication called adenosine our dose for this is going to be six milligrams rapid iv push and we can give two subsequent doses of 12 milligrams so it's really important that you guys get this medication in very quickly so oftentimes we'll set up a three-way stopcock where we can give the medication then immediately followed up with a 10 ml flush so now if we've done that assessment and our patient is not unstable then we actually want to assess whether they have a wide or narrow qrs determined by if the qrs complex is greater than 0.12 seconds now if they do have a wide qrs then there's a couple things that we want to do first we want to ensure that we have iv access and then we want to get a 12 lead ecg now in this situation we can consider using adenosine again if it's regular and monomorphic we also want to consider the use of some sort of antiarrhythmic medication this is going to be things like amiodarone procainamide sodolol and then if our patient is in polymorphic vtac then we also want to consider the use of one to two grams of magnesium at this point we do want to consider that expert consultation with a cardiologist now if their qrs is narrow then we do want to consider again ensuring that we have iv access and getting that 12 lead ecg in these cases we can consider having the patient try vagal maneuvers these are going to be things like asking them to bear down like they're having to have a bowel movement you can try having them blow real hard through a small straw as well as if you are properly trained you can also do the external carotid massage now like i said if they have a regular rhythm and it's narrow then we can consider the use of adenosine but do also keep in mind though that sinus tachycardia is often a normal physiological response so think our compensation mechanism for something else that's going on with the patient and these can be things like fever hypovolemia shock etc now again for the narrow qrs things like beta blockers and calcium channel blockers may also be helpful and then again we want to consider that expert consultation of a cardiologist so remember here that our assessment and management of our patient with tachycardia is really going to revolve around a few key questions are symptoms present or not are they stable or unstable is the qrs narrower wide is the rhythm regular or irregular is the qrs monomorphic or polymorphic and then really based on the answers to these questions that this can guide us to the next appropriate steps in helping our patients all right and that completes our review of the recommendations from the aha when it comes to tachycardia and the acls algorithm for that again i really hope that you guys enjoyed this lesson and found it valuable if you did please leave me 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check out a couple awesome lessons i'm gonna link to right here for you guys as always thank you so much for watching have a great day