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Tachycardia with a Pulse, CPR Nashville

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Tachycardia With A Pulse Algorithm Tachycardia With a Pulse Treatment
Ventricular Tachycardia,Supraventricular Tachycardia/Rapid Atrial Fibrillation/Atrial Flutter

In some cases tachycardia can be causes from dehydration, exercise, caffeine, and blood loss.
In more acute situations, tachycardia is caused because of an extra electrical connection going between the atria (upper chambers) and ventricles (lower chambers) of the heart.
It can also occur when there is an abnormal piece of heart muscle present. This abnormal piece of heart muscle that is present can cause the electricity in the heart to loop continuously back to the atria and at the same down to the ventricles. These abnormalities in the electrical currents through the heart can lead to life threatening arrhythmias such as Supra Ventricular Tachycardia (SVT), Atrial Fibrillation, Atrial Flutter, Polymorphic Ventricular tachycardia, and many more.

Identifying Stable verses Unstable Tachycardia:
The first step is identifying the underlying cause of the tachycardia and determining whether or not the patient is stable or unstable. Obtaining a history, vital signs, physical assessment and and ECG with help establish whether the patient is stable our unstable. If the patient is hypoxemic, apply oxygen and assist with breathing if necessary.
Some signs and symptoms of unstable tachycardia include:

  • Hypotension
  • Acutely Altered Mental Status
  • Signs of Shock
  • Ischemic Chest Discomfort
  • Acute Heart Failure
  • Heart Rate Greater than 150 beats per minute

Treatment of Tachycardia With a Pulse:

Stable Tachycardia Treatment-

If your patient with a heart rate greater than 150 beats per minute is able to speak to you without difficulty, has a stable blood pressure and oxygen saturation, and is not experiencing any signs of chest discomfort; proceed to the 6 ACLS algorithm interventions listed below.

  1. Establish peripheral intravenous access
  2. Obtain and ECG if one has not yet been completed
  3. Attempt Vagal Maneuvers Such As
    1. Ask the patient to blow on their thumb like it is a trumpet
    2. Ask the patient to bear down like they are having a bowel movement.
    3. Apply ice cold wash cloths to the patient’s face for five to ten seconds
    4. If the SVT is regular, administer 6mg of Adenosine/Adenocard through the peripheral iv.
    5. Beta Blockers and Calcium Channel Blockers may be used.
    6. Consider Expert Consultation

Stable but Rhythm has a QRS greater than or Equal to 0.12 seconds-
Just as above establish IV access and obtain an ECG

  1. Consider Adenosine 6mg IV if the rhythm is regular and monomorphic (the goal of this is to slow the rhythm down in order to see what the underlying rhythm is)
  2. Consider an antiarrhythmic infusion
  3. Consider Expert Consultation 


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Unstable Tachycardia With a Pulse-

If the patient is unstable and experiencing any of the unstable symptoms above, move to:

  1. Syncronized Cardioversion (Consider Sedation)
  2. If regular and narrow complex consider Adenosine 6mg IV push followed by a normal saline flush.
  3. Support airway and continue to monitor vital signs
  4. A second dose of Adenosine may be administered if required and should be a dose of 12mg by IV push followed by a flush.

Treatments Defined
This treatment can either by delivered synchronized or unsynchronized. Please see attached American Heart Association Handout that explains the difference and when each are indicated.

In supraventricular tachycardia, Adenosine is used as an antiarrhythmic to slow the heart rate to identify the underlying cardiac rhythm. If the fast rate is due to atrial fibrillation, atrial flutter, or monomorphic ventricular tachycardia, adenosine generally does not break the rate. Adenosine however is in some cases able to break the rate long enough to identify the real rhythm. If the Supraventricular tachycardia is AV Node dependent, Adenosine can sometimes terminate the SVT altogether. When this happens the heart can experience ventricular asystole for a few seconds. This can be very scary to the patient and can even cause them pain. Because of this, if the patient is conscious and stable enough, sedation is recommended.

Cardiac Ablation

This is a procedure where areas of the heart are electrically inactivated (ablated) in order to prevent recurrent cardiac arrhythmias from originating from that specific area of the heart.


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