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Cardiology
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Adult Tachycardia (ACLS)
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Unstable = cardioversion. Stable narrow = adenosine/vagal. Stable wide = consider VT.
Decision
Outcome
Decision
Sustained tachyarrhythmia (HR typically >150). First step?
✓
ID and treat underlying cause; airway, O₂, monitor, BP
✗
Cardiovert everyone immediately
Decision
Are there unstable features (hypotension, AMS, shock, ischemic chest pain, AHF)?
✓
Yes → synchronized cardioversion
✓
No → assess QRS width
Outcome
Synchronized cardioversion (sedate first); consider adenosine if regular narrow complex
Decision
QRS ≥0.12 s (wide)?
✓
Yes (wide) → IV access, 12-lead, consider adenosine if regular & monomorphic, antiarrhythmic infusion
✓
No (narrow) → vagal maneuvers, adenosine if regular, β-blocker or CCB
Outcome
Treat as VT until proven otherwise — amiodarone, procainamide, or sotalol
Outcome
Vagal → adenosine 6 mg → 12 mg → rate control (diltiazem/metoprolol) for AF/aflutter