Template:ACLS Narrow Regular Tachycardia

Sinus tachycardia
- Treat underlying cause
SVT
- Vagal maneuvers (convert up to 25%)
- Adenosine 6mg rapid IV push if patient hemodynamically stable (unstable should proceed directly to electrical cardioversion)
  - Can follow with repeat dose of 6 mg or 12mg if initially fails
  - If adenosine fails, initiate rate control with calcium channel blocker or beta blocker or use synchronized cardioversion
    - Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
    - Metoprolol 5mg IVP x 3 followed by 50mg PO
- Synchronized cardioversion (50-100J)
  - Provide sedation prior to synchronized cardioversion if patient is hemodynamically stable
Atrial flutter
- Stable: Consider rate control to HR < 110 bpm
- Unstable: Synchronized cardioversion; start at 50J