ACLS: Tachycardia

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3 questions

  1. Is the patient in a sinus rhythm?
  2. Is the QRS wide or narrow?
  3. Is the rhythm regular or irregular?


Algorithm for tachycardia with a pulse (Adapted from ACLS 2010)

Narrow Regular

See also Tachycardia (Narrow)

Narrow Irregular


Wide Regular

  • If pulseless: shock (unsynchronized 200J)
  • 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)

Wide Irregular

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

  1. A fib with preexcitation
  2. A fib with aberrancy
  3. Polymorphic V-Tach / Torsades De Pointes

See Also

External Links