Assess primary ABCDs
1. Pt responsive
2. Pt breathing
3. Pt has a pulse present - Rapid
4. Do not defibrillate a rhythm if there is a pulse. Do not cardiovert if the patient is stable.
Assess secondary ABCDs
1. Secure airway if needed
2. "O2, IV, Monitor"- place on O2, place an IV, and place on a heart
monitor
3. Check Vital Signs - if no signs of poor perfusion, then patient is stable
4. Review history and physical exam
5. Get a 12 lead ECG
6. Get a portable Chest X-Ray
Assess Rapid Heart Rate as Narrow or Wide Complex Tachycardia?
Narrow if QRS complex is < 0.12 seconds or < 3 small boxes on the ECG srip:
If patient is stable, usually ventricular rate is less than 150 bpm
and no Signs and Symptoms (not even one) are not present or if there are no signs of poor perfusion like chest pain, shortness of
breath, decreased level of consciousness (L.O.C.), decreased BP,
shock, pulmonary congestion, CHF, Acute MI
Determine tachycardia rhythm: Atrial Fibrillation, Atrial Flutter, Supraventricular Tachycardia (SVT) are types of narrow complex tachycardias.
*Note:
Is Wolfe Parkinson White (WPW) present?
Is the duration of the A. fib./A. flutter < 48 hrs or > 48 hrs?
*NOTE: If A.fib/A.flutter > 48hrs, use agents to convert rhythm with extreme caution due to embolic complications
Treatments:
Control Rate:
Use diltiazem, drug of choice for Atrial Fibrillation.
Use beta-blockers
Digoxin
Adenosene is the drug of choice for SVT (vagal manuevers may be done with SVT, first; Do not do carotid massage without auscultation of absence of a bruit, and do not do both at the same time due to cutting off the circulation to the brain.
If not converted, then:
< 48 hrs - Cardioversion
> 48 hrs - No Cardioversion, then delayed cardioversion, anticoagulation is recommended, to reduce the chance of the patient throwing clots.
