Management

Initial management

  • Assess with ABCDE approach
  • Check for life-threatening features:

Life-threatening features present

  • Give up to 3 synchronised DC shocks
    • Give sedation or anaesthesia if conscious
  • If unsuccessful:
    • Amiodarone 300mg IV over 10-20 minutes
    • Repeat synchronised DC shock

No life-threatening features present

If QRS broad (>0.12s) and regular:

  • Assume it is a ventricular tachycardia (VT) unless it is a previously confirmed supraventricular tachycardia (SVT) with bundle branch block
    • If VT: give IV 300mg amiodarone over 10-60min
    • If previously confirmed SVT with bundle branch block: treat as regular narrow complex tachycardia
    • If above measures ineffective: up to 3 synchronised DC shocks
      • If conscious, use sedation or anaesthesia before delivering shocks

If QRS broad (>0.12s) and irregular:

  • Atrial fibrillation with bundle branch block:
    • Consider rate control with beta-blocker
    • Consider digoxin or amiodarone if evidence of heart failure
    • Anticoagulation if >48 hours
  • Polymorphic VT e.g. torsades de pointes
    • IV magnesium 2g over 10 minutes

If QRS narrow (<0.12s) and regular:

  • Vagal manoeuvres e.g. carotid sinus massage/Valsalva manoeuvre
  • If ineffective: IV adenosine 6mg bolus + continuous ECG monitoring
    • If ineffective then IV adenosine 12mg bolus
    • If ineffective then IV adenosine 18mg bolus
    • If ineffective: verapamil or beta-blocker
    • If above measures ineffective: up to 3 synchronised DC shocks
      • If conscious, use sedation or anaesthesia before delivering shocks

If QRS narrow (<0.12s) and irregular:

  • Probable atrial fibrillation:
    • Consider rate control with beta-blocker
    • Consider digoxin or amiodarone if evidence of heart failure

Anticoagulation if >48 hours

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