Template:ACLS Wide Regular Tachycardia: Difference between revisions
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**[[Synchronized cardioversion]] 100-200J | **[[Synchronized cardioversion]] 100-200J | ||
*'''Stable''': | *'''Stable''': | ||
* | *#Medications | ||
* | *#*[[Procainamide]] | ||
* | *#**20-50mg/min; then maintenance infusion of 1-4mg/min x6hr | ||
* | *#**Treat until arrhythmia suppressed, QRS duration increases >50%, hypotension, Max 17mg/kg or 1 gram | ||
* | *#**Avoid if prolonged QT or CHF | ||
***[[Amiodarone]] | *#*[[Procainamide]] 100 mg q5min at max rate of 25-50 mg/min<ref>Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.</ref> | ||
* | *#**Until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure) '''OR''' | ||
* | *#**Max 17 mg/kg total dose given (12 mg/kg if renal failure) '''OR''' | ||
* | *#**If QRS widens > 50% | ||
* | *#**Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively <ref>Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017 May 1;38(17):1329-1335</ref> | ||
*#*[[Amiodarone]] | |||
*#**150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr | |||
*#*[[Adenosine]] | |||
*#**May be considered for diagnosis and treatment only if rhythm is regular and monomorphic | |||
*#Synchronized [[Cardioversion]] (100J) | |||
Revision as of 11:14, 14 March 2018
Wide Regular Tachycardia
Pulseless: see Adult pulseless arrest
- Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
- Synchronized cardioversion 100-200J
- Stable:
- Medications
- Procainamide
- 20-50mg/min; then maintenance infusion of 1-4mg/min x6hr
- Treat until arrhythmia suppressed, QRS duration increases >50%, hypotension, Max 17mg/kg or 1 gram
- Avoid if prolonged QT or CHF
- Procainamide 100 mg q5min at max rate of 25-50 mg/min[1]
- Until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure) OR
- Max 17 mg/kg total dose given (12 mg/kg if renal failure) OR
- If QRS widens > 50%
- Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively [2]
- Amiodarone
- 150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
- Adenosine
- May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
- Procainamide
- Synchronized Cardioversion (100J)
- Medications
- ↑ Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.
- ↑ Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017 May 1;38(17):1329-1335