ACLS Megacode 3: Narrow Complex Tachycardia

An 83-year-old female with H/O hypertension and diabetes presents to the emergency department for evaluation of palpitations and fatigue.

Initial vitals:

T: 36.5, R: 20, P: 160s, BP: 140/80, O₂: 100%

The monitor demonstrates the following with rate of approximately 150s-160s:

Despite vagal maneuvers, the patient remains persistently tachycardic.

After attempting vagal maneuvers and rate controlling agents, the patient remains persistently tachycardic.

She now complains of feeling very light-headed. She is diaphoretic and blood pressure drops to 70s/30s.

After synchronized cardioversion, the patient feels improved.

Heart rate is 110, BP 130/60, and repeat rhythm strip demonstrates the following:

The patient starts to feel light-headed again.

She is mentating appropriately. Repeat vitals demonstrate P: 180, BP: 120/70.

Rhythm strip demonstrates the following: