Analysis of the AHA Year 2000 ACLS Guidelines
ACLS EMS Quick Summary Overview

Tachycardia

  Affirm completion of initial ABCD
Initiate Secondary ABCD

Pulse present?

• Obtain vital signs
• Pulse oximetry
• 12-lead ECG
• History
• Physical exam

Serious signs or symptoms of tachycardia?

• Is the tachycardia the problem itself, (or a sign/symptom of another problem needing correction?)
• Is the patient stable or unstable (chest pain, dyspnea, decreased level of conciousness, low BP, CHF, AMI)?

If Unstable:

• Establish HR as cause of symptoms (almost always HR>150)
• Consider synchronized cardioversion
  (M Series biphasic: 60J, 120J, 180J, 200-220J or conventional 100J, 200J, 300J, 360J)
  with sedation (suction, advanced airway management ready).

If Stable: Analysis of 12-lead EKG can further help make the diagnosis.

• Narrow Complex
  • PSVT, Junctional, Multifocal Atrial Tach:
    • Initially, Vagal Maneuvers (avoid carotid sinus massage and cold water/face applications to cardiac patients);
    • Adenosine 6 mg, then 12 mg q 1-2 min X 2 doses if necessary;
    • Other drugs to consider: Amiodarone (150 mg over 10 min), Verapamil (initial dose 2.5 - 5 mg over 2 minutes, additional doses 5-10 mg q 15-30 min), Beta-blockers (dose dependent on drug).
  • A fib, flutter: Caution: How long has the condition been present? Chronic condition (>48 hrs)--conversion needs to be preceeded by anti-coagulation therapy. Conversion options include meds listed above for narrow complex tachycardia.
    
    
• Stable VT-Monomorphic:
  • Procainamide 30 mg/min up to 17 mg/kg (preferred agent)-can also be given up to 50 mg/min or 100mg q 5 min as alternative delivery during urgent/emergent situations;
  • Can also consider Lidocaine IV 1-1.5 mg/kg (can be repeated 0.5-0.75 mg/kg q 5-10 min up to 3 mg/kg) or
  • Amiodarone 150 mg over 10 min IV.
    
    
• Stable VT-Polymorphic (prolonged QT interval in intervening rhythm, torsades des pointes): Consider
  • 1-2 gm/10cc IV push Magnesium sulfate;
  • Overdrive Pacing;
  • Isuproterenol;
  • Lidocaine.
     

*EMS—does not include additional medications such as specific beta-blockers, digoxin, or other calcium channel blockers.
See previous Protocols or use ECC handbook 2000 for further explanation, dosages, and reference.

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