Unstable Tachycardia – NurseCheung.com https://nursecheung.com From "You're Not Good Enough" To "Look At Me Now!" Wed, 06 Dec 2023 15:11:19 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.5 https://2hya11.p3cdn1.secureserver.net/wp-content/uploads/2023/01/nurse-cheung-logo-Logo-1000-×-1000-px-2-150x150.png Unstable Tachycardia – NurseCheung.com https://nursecheung.com 32 32 Out-Of-Hospital ACLS Unstable Tachycardia Megacode: The Most Effective Strategies https://nursecheung.com/aclsmegacode-ooh-unstabletachycardia/ Sat, 07 Jan 2023 17:14:22 +0000 https://nursecheung.com/out-of-hospital-acls-unstable-tachycardia-megacode-the-most-effective-strategies/

ACLS or Advanced Cardiac Life Support is a set of clinical guidelines that are used to treat cardiac arrest and other life-threatening medical emergencies.

One of the most common arrhythmias that ACLS providers will encounter is unstable tachycardia.

In this blog post, we will discuss the most effective strategies for managing unstable tachycardia using the ACLS megacode.

Adult Out-Of-Hospital Unstable Tachycardia Megacode Scenario

The following is a scenario in which you would use the out-of-hospital adult unstable tachycardia megacode:

You are working on an advanced life support ambulance and are dispatched to a person who doesn’t feel right.

Demonstrate what you would do next upon arrival

Initial Impression

The person is a 58-year-old female lying down in the front doorway of her home. She is anxious, pale, and dizzy.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is patent but is experiencing mild respiratory distress. The flow through the trachea is not impaired.

Breathing: Oxygenation is showing 92% on room air. You provide oxygen 2LNC.

Circulation: Blood pressure is 92/60, heart rate is not being captured on the monitor, the rhythm check shows monomorphic wide complex ventricular tachycardia and the pulse is present.

Disability: The woman is alert but anxious and diaphoretic.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet. The woman’s son states he helped her to the doorway to get some cold air. He denies any falls or injuries.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” The woman responds but is weak.
  2. Activate the emergency response system. You direct the second rescuer to activate the emergency response system and get an AED.
  3. Check for breathing: Look for visible chest rising and falling. Breathing is rapid and present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but fast.
 

What are your next actions?

Pulse and breathing are present so we will not begin CPR starting with compressions.

Unstable Tachycardia Algorithm

Identify and Treat the Underlying Cause

  1. Maintain patent airway, assist with breathing if necessary – Airway is patent and breathing is spontaneous
  2. Oxygen (if hypoxemic) – The woman is on 2LNC upon Primary Assessment
  3. Cardiac monitor, blood pressure, oximetry – monomorphic wide complex ventricular tachycardia, BP 92/60, 96% on 2LNC
  4. IV Access – 20 gauge in the right antecubital
  5. 12-Lead ECG if available and doesn’t delay therapy – Not readily available
 

Persistent Tachyarrhythmia Causing

  • Hypotension? – YES
  • Acutely altered mental status? – NO
  • Signs of shock (low blood pressure, altered mental status, cold moist skin, weak or rapid pulse, rapid breathing, decreased urine output) – YES
  • Ischemic chest discomfort? – YES, woman states chest discomfort
  • Acute heart failure (heavy breathing, suffocating sensation, struggle to breathe while lying down, tight chest, arrhythmia, cough, fluid retention, loss of consciousness)? – YES
 

Interventions

What interventions could you perform next?

  • Synchornized Cardioversion – Consider sedation
 

If synchronized cardioversion is not effective or contraindicated:

  • Amiodarone IV Drip: 1-4 mg/min
  • Procainamide 20-50 mg/min until the arrhythmia is suppressed, hypotension ensues, QRS duration increases. There is a maintenance infusion dose.
  • Sotalol 100 mg (1.5 mg/kg) over 5 minutes. Avoid if QT is prolonged.
 

Outcomes

Two attempts at synchronized cardioversion were performed unsuccessfully. No change in rhythm was noted.

Amiodarone infusion started. After 5 minutes, another attempt at synchronized cardioversion was attempted and successful.

Rhythm is now normal sinus rhythm at 80 bpm.

 

You will begin the transfer to the nearest hospital. Your scenario has concluded.

]]> Emergency Department ACLS Unstable Tachycardia Megacode: The Most Effective Strategies https://nursecheung.com/aclsmegacode-ed-unstabletachycardia/ Sat, 07 Jan 2023 17:14:20 +0000 https://nursecheung.com/emergency-department-acls-unstable-tachycardia-megacode-the-most-effective-strategies/

ACLS or Advanced Cardiac Life Support is a set of clinical guidelines that are used to treat cardiac arrest and other life-threatening medical emergencies.

One of the most common arrhythmias that ACLS providers will encounter is unstable tachycardia.

In this blog post, we will discuss the most effective strategies for managing unstable tachycardia using the ACLS megacode.

Adult Emergency Department Unstable Tachycardia Megacode Scenario

The following is a scenario in which you would use the emergency department adult unstable tachycardia megacode:

You are working in the emergency department and are assessing a woman who has had multiple reports of syncopal episodes and palpitations.

Demonstrate what you would do next upon arrival

Initial Impression

The patient is a 32-year-old female lying down on the stretcher. She is anxious, pale, weak, and dizzy. She states these episodes have happened over the last few years but have become more frequent recently.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is patent. The flow through the trachea is not impaired.

Breathing: Oxygenation is showing 96% on room air.

Circulation: Blood pressure is 84/60, heart rate is 160 bpm, the rhythm check shows narrow complex supraventricular tachycardia and the pulse is present.

Disability: The woman is alert but anxious and diaphoretic.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the patient’s palpitations become worse and she is short of breath.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” The woman responds but is becoming increasingly weak.
  2. Activate the emergency response system. Shout for backup and announce what room you are in.
  3. Check for breathing: Look for visible chest rising and falling. Breathing is rapid and present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but fast.
 

What are your next actions?

Pulse and breathing are present so we will not begin CPR starting with compressions.

Unstable Tachycardia Algorithm

Identify and Treat the Underlying Cause

  1. Maintain patent airway, assist with breathing if necessary – Airway is patent and breathing is spontaneous
  2. Oxygen (if hypoxemic) – The woman is on 4LNC upon Primary Assessment
  3. Cardiac monitor, blood pressure, oximetry – narrow complex supraventricular tachycardia, BP 84/60, 94% on 4LNC
  4. IV Access – 20 gauge in the right and left antecubital
  5. 12-Lead ECG if available and doesn’t delay therapy – Not readily available
 

Persistent Tachyarrhythmia Causing

  • Hypotension? – YES
  • Acutely altered mental status? – NO
  • Signs of shock (low blood pressure, altered mental status, cold moist skin, weak or rapid pulse, rapid breathing, decreased urine output) – YES
  • Ischemic chest discomfort? – YES, the patient states chest discomfort from palpitations
  • Acute heart failure (heavy breathing, suffocating sensation, struggle to breathe while lying down, tight chest, arrhythmia, cough, fluid retention, loss of consciousness)? – YES
 

Interventions

What interventions could you perform next?

  • Synchronized Cardioversion – Consider sedation
 

If synchronized cardioversion is not effective or contraindicated:

  • Adenosine IV – First dose 6mg rapid IV push followed by NS flush, Second dose 12 mg if required
 

Outcomes

Two attempts at synchronized cardioversion were performed successfully.

Rhythm is now normal sinus rhythm at 80 bpm.

Next steps for this patient:

  • Labs – electrolytes and cardiac biomarkers
  • Fluids
  • Chest x-ray
  • Cardiac Consultation
  • Transfer to a higher level of care
 
 

You will begin the transfer to a higher level of care. Your scenario has concluded.

]]> Inpatient ACLS Unstable Tachycardia Megacode: The Most Effective Strategies https://nursecheung.com/aclsmegacode-ip-unstabletachycardia/ Sat, 07 Jan 2023 17:14:18 +0000 https://nursecheung.com/inpatient-acls-unstable-tachycardia-megacode-the-most-effective-strategies/

ACLS or Advanced Cardiac Life Support is a set of clinical guidelines that are used to treat cardiac arrest and other life-threatening medical emergencies.

One of the most common arrhythmias that ACLS providers will encounter is unstable tachycardia.

In this blog post, we will discuss the most effective strategies for managing unstable tachycardia using the ACLS megacode.

Adult inpatient Unstable Tachycardia Megacode Scenario

The following is a scenario in which you would use the emergency department adult unstable tachycardia megacode:

You are a healthcare provider working in the cardiovascular intermediate care unit. You are caring for a post-motor vehicle trauma patient with a chest tube. The patient’s wife runs into the nurse’s station yelling that her husband needs help.

Demonstrate what you would do next upon arrival

Initial Impression

The patient is a 30-year-old male lying down in a hospital bed. He is anxious, pale, weak, and dizzy. He states his chest feels funny.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is patent. The flow through the trachea is not impaired.

Breathing: Oxygenation is showing 96% on room air.

Circulation: Blood pressure is 84/60, heart rate is 160 bpm, the rhythm check shows narrow complex supraventricular tachycardia and the pulse is present.

Disability: The patient is alert but anxious and diaphoretic.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the patient’s palpitations become worse and he is short of breath.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” The man responds but is becoming increasingly weak.
  2. Activate the emergency response system. Shout for backup and announce what room you are in.
  3. Check for breathing: Look for visible chest rising and falling. Breathing is rapid and present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but fast.
 

What are your next actions?

Pulse and breathing are present so we will not begin CPR starting with compressions.

Unstable Tachycardia Algorithm

Identify and Treat the Underlying Cause

  1. Maintain patent airway, assist with breathing if necessary – Airway is patent and breathing is spontaneous
  2. Oxygen (if hypoxemic) – The patient is on 4LNC after a change in condition
  3. Cardiac monitor, blood pressure, oximetry – narrow complex supraventricular tachycardia, BP 84/60, 94% on 4LNC
  4. IV Access – 20 gauge in the right and left antecubital
  5. 12-Lead ECG if available and doesn’t delay therapy – Not readily available
 

Persistent Tachyarrhythmia Causing

  • Hypotension? – YES
  • Acutely altered mental status? – NO
  • Signs of shock (low blood pressure, altered mental status, cold moist skin, weak or rapid pulse, rapid breathing, decreased urine output) – YES
  • Ischemic chest discomfort? – YES, the patient states chest discomfort from palpitations
  • Acute heart failure (heavy breathing, suffocating sensation, struggle to breathe while lying down, tight chest, arrhythmia, cough, fluid retention, loss of consciousness)? – YES
 

Interventions

What interventions are available for you to perform next?

  • Synchronized Cardioversion – Consider sedation
  • Adenosine IV – First dose 6mg rapid IV push followed by NS flush, Second dose 12 mg if required
 

What are we Missing?

The chest tube is a vital piece of equipment during our assessment that may be a contributing factor. Previously during our initial assessment, there was minimal drainage. Now the drainage is over 1,500 mL.

Outcomes

The patient was taken to the Operating Room and found to have a hemothorax.

Next steps for this patient:

  • Post-operative care
  • Chest tube management
  • Physical therapy and walking schedule
  • Labs – electrolytes and cardiac biomarkers
  • Fluids including blood products
  • Chest x-ray
  • Cardiac Consultation
  • Transfer to a higher level of care
 
 

You will begin the transfer to a higher level of care. Your scenario has concluded.

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