Template:ACLS Wide Irregular Tachycardia

ACLS: Wide Irregular Tachycardia

DO NOT use AV nodal blockers as they can precipitate V-Fib

Pulseless: see Adult pulseless arrest

• Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
  • Unsynchronized cardioversion (defibrillation) 200J
• Stable:
  1. A fib with preexcitation
     • 1st line - Electric Cardioversion
     • 2nd line - Procainamide, amiodarone, or sotalol
  2. A fib with aberrancy
  3. Polymorphic V-Tach / Torsades De Pointes
     • Give IV MgSO4
     • Emergent defibrillation (NOT synchronized)
     • Correct electrolyte abnormalities (esp hypoK, hypoMg)
     • Stop prolonged QT meds