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Adult With Bradycardia Pulse Algorithm

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ADULT BRADYCARDIA WITH PULSE ALGORITHM

Tachycardia is a heart rate of greater than 100 beats per minute. When the heart beats too quickly, there is a shortened relaxation phase. This causes two main problems: 1) the ventricles are unable to fill completely, causing cardiac output to lower and 2) the coronary arteries receive less blood, causing supply to the heart to decrease.

  • Tachycardia is classified as stable or unstable
  • Heart rates ≥ 150 beats per minute usually cause symptoms
  • Unstable tachycardia always requires prompt attention
  • Stable tachycardia can become unstable

SYMPTOMS OF TACHYCARDIA

  • Hypotension
  • Sweating
  • Pulmonary edema/congestion
  • Jugular venous distension
  • Chest pain/discomfort
  • Shortness of breath
  • Weakness/dizziness/lightheadedness
  • Altered mental state

TACHYCARDIA WITH PULSE HR > 100 BPM SYMPTOMATIC
  1. Remember if the patient is UNSTABLE, provide IMMEDIATE SYNCHRONIZED CARDIOVERSION.

    • Is the patient’s tachycardia producing hemodynamic instability and serious symptoms?
    • Are the symptoms (i.e., pain and distress of an AMI) producing the tachycardia?
  2. Assess patient’s hemodynamic status (IV, O2 , Monitor)

    • HR 100 to 130 bpm is usually result of underlying process and often represents sinus tachycardia. In sinus tachycardia the goal is to identify and treat the underlying systemic cause.
    • HR > 150 bpm may be symptomatic; the higher the rate, the more likely the symptoms are due to the tachycardia.
  3. Asses Complex

    REGULAR NARROW COMPLEX TACHYCARDIA (PROBABLE SVT)

    • Attempt vagal maneuvers.
    • Obtain 12-lead ECG; consider expert consultation.
    • Adenosine 6 mg rapid IVP. If no conversion, give 12 mg IVP (2nd dose). May attempt 12 mg once.

    IRREGULAR NARROW COMPLEX TACHYCARDIA (PROBABLE A-FIB)

    • Obtain 12-lead ECG; consider expert consultation.
    • Control rate with diltiazem 15 to 20 mg (0.25 mg/kg) IV over 2 minutes or beta-blockers.

    REGULAR WIDE COMPLEX TACHYCARDIA (PROBABLE VT)

    • Obtain 12-lead ECG; consider expert consultation.
    • Convert rhythm using amiodarone 150 mg IV over 10 minutes.
    • Elective cardioversion.

    IRREGULAR WIDE COMPLEX TACHYCARDIA

    • Obtain 12-Lead ECG; consider expert consultation.
    • Consider anti-arrhythmic.
    • If Torsades de Pointes give magnesium sulfate 1 to 2 gm IV; may follow with 0.5 to 1 gm over 60 minutes.

If at any point you become uncertain or uncomfortable during the treatment of a stable patient, seek expert consultation. The treatment of stable patients can be potentially harmful.


Adenosine may cause bronchospasm; therefore, adenosine should be given with caution to patients with asthma.


Synchronized cardioversion is appropriate for treating wide complex tachycardia of unknown type. Prepare for synchronized cardioversion as soon as a wide complex tachycardia is detected.


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