Template:ACLS Wide Regular Tachycardia: Difference between revisions
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===[[Wide complex tachycardia|Wide ''Regular'' Tachycardia]]=== | ===[[Wide complex tachycardia|Wide ''Regular'' Tachycardia]]<ref>American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 7: Adult Advanced Cardiovascular Life Support. ECCguidelines.heart.org</ref>=== | ||
''Pulseless: see [[Adult pulseless arrest]]'' | ''Pulseless: see [[Adult pulseless arrest]]'' | ||
*'''Unstable''': Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure | *'''Unstable''': Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure | ||
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*#Medications | *#Medications | ||
*#*[[Procainamide]] | *#*[[Procainamide]] | ||
*#**20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min | *#**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> | ||
*#**Stop if QRS duration increases >50% or [[hypotension]] | *#**Stop if QRS duration increases >50% or [[hypotension]] | ||
*#**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]] | ||
*#**150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr | *#**150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr | ||
Revision as of 11:50, 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
- 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
- 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
- ↑ 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