Template:ACLS Wide Regular Tachycardia: Difference between revisions
| Line 5: | Line 5: | ||
*'''Stable''': | *'''Stable''': | ||
*#Medications | *#Medications | ||
*#*[[Procainamide]] (first line drug of choice) | *#*[[Procainamide]] (first-line drug of choice) | ||
*#**20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr | *#**20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr | ||
*#***Alternative administration: 100 mg q5min at max rate of 25-50 mg/min<ref>Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.</ref> | *#***Alternative administration: 100 mg q5min at max rate of 25-50 mg/min<ref>Procainamide. GlobalRPH. http://www.globalrph.com/procainamide_dilution.htm.</ref> | ||
| Line 11: | Line 11: | ||
*#**Avoid if [[prolonged QT]] or [[CHF]] | *#**Avoid if [[prolonged QT]] or [[CHF]] | ||
*#**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> | *#**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]] | *#*[[Amiodarone]] (agent of choice in setting of [[AMI]] or LV dysfunction) | ||
*#**150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)<ref>Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.</ref> | *#**150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)<ref>Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.</ref> | ||
*#**Then 0.5 mg/min drip over next 18 hrs (540 mg total) | *#**Then 0.5 mg/min drip over next 18 hrs (540 mg total) | ||
*#**Oral dosage after IV infusion is 400 -800 mg PO daily | *#**Oral dosage after IV infusion is 400 -800 mg PO daily | ||
*#*[[ | *#*Consider [[adenosine]] | ||
*#** | *#**Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see [[rhythm diagnosis in regular wide complex tachycardia]]) | ||
*#**6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push | *#**6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push | ||
*#Synchronized [[Cardioversion]] (100J) | *#Synchronized [[Cardioversion]] (100J) | ||
Revision as of 12:10, 14 March 2018
Wide Regular Tachycardia[1]
Pulseless: see Adult pulseless arrest
- Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
- Synchronized cardioversion 100-200J
- Stable:
- Medications
- Procainamide (first-line drug of choice)
- 20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
- Alternative administration: 100 mg q5min at max rate of 25-50 mg/min[2]
- Stop if QRS duration increases >50% or hypotension
- Avoid if prolonged QT or CHF
- 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 [3]
- 20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
- Amiodarone (agent of choice in setting of AMI or LV dysfunction)
- 150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)[4]
- Then 0.5 mg/min drip over next 18 hrs (540 mg total)
- Oral dosage after IV infusion is 400 -800 mg PO daily
- Consider adenosine
- Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see rhythm diagnosis in regular wide complex tachycardia)
- 6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push
- Procainamide (first-line drug of choice)
- Synchronized Cardioversion (100J)
- Medications
- ↑ American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 7: Adult Advanced Cardiovascular Life Support. ECCguidelines.heart.org
- ↑ 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
- ↑ Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.