Template:ACLS Wide Regular Tachycardia

ACLS: Wide Regular Tachycardia

• If pulseless: shock (unsynchronized 200J)
  • See Adult Pulseless Arrest
• If unstable: shock (synchronized 100J)
  • Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
• If stable:
  • Meds
    • 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
      • 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)