Adult Tachycardia With Pulse Management Algorithm

DOSES/DETAILS

Synchronized Cardioversion:

• Narrow regular: 50 to 100J
• Narrow irregular: Biphasic 120J to 200J Monophasic 200J
• Wide regular: 100J
• Wide irregular: defibrillation dose (NOT synchronized)

Adenosine IV Dose:

• Initial dose of 6 mg rapid IV push; follow with NS flush.
• Follow with second dose of 12 mg if required.

Antiarrhythmic Infusions for stable wide QRS tachycardia:

Procainamide IV Dose:

• 20 to 50 mg per minute until arrhythmia suppressed, hypotension ensues, or QRS duration increases >50%, maximum dose 17 mg/kg given.
• Maintenance infusion: 1 to 4 mg per minute. Avoid if prolonged QT or CHF

Amiodarone IV Dose:

• Initial dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
• Maintenance infusion: 1 mg per minute for first six hours

Sotalol IV Dose:

• 100 mg (1.5 mg/kg) over five minutes. Avoid if prolonged QT