Tachycardias in the Resuscitation Room

Author: Gavin Lloyd, Beth Newstead / Editor: Steve Fordham / Reviewer: Reuben Cooper, Jessie Lynch / Codes: A1, R1 / Published: 20/01/2023

This session covers the management of tachycardic patients. 

After completing this session you will be able to:

  • Classify tachycardias
  • Recognise the appearance of different tachycardias
  • Manage clinically stable and unstable patients with specific tachycardias
  • Be aware of areas of controversy in the management of patients with tachycardias
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References:

  1. Resuscitation Guidelines 2021. Resuscitation Council UK.
  2. National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. NICE [NG196], 2021.
  3. Mehta D. Wafa S. Ward DE. et al. 3. Mehta D. Wafa S. Ward DE. et al. Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia. Lancet 1998; 1(8596):1181-5.
  4. Walker S. Cutting P. Impact of a modified Valsalva manoeuvre in the termination of supraventricular tachycardia. Emerg Med J 2010; 27:287-291.
  5. Holdgate A. Foo A. Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database of Systematic Reviews 2006; (4):CD005154.
  6. Terry P. Lumsden G. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Using intravenous adenosine in asthmatics. Emergency Medicine Journal 2001; 18(1):61.
  7. Royal College of Emergency Medicine (RCEM). Best Practice Guideline: Procedural Sedation in the Emergency Department. August 2022.
  8. Buttner R, Burns E. Atrial Flutter. Life In The Fast Lane (LITFL). February 2022.
  9. Burns E, Buttner R. Multifocal Atrial Tachycardia (MAT). Life In The Fast Lane (LITFL). June 2021.
  10. Burns E, Buttner R. Atrial Fibrillation. Life In The Fast Lane (LITFL). December 2021.
  11. Ortiz M, Martn A, Arribas F, Coll-Vinent B, Del Arco C, Peinado R, Almendral J; PROCAMIO Study Investigators. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2017 May 1;38(17):1329-1335.
  12. Brugada P. Brugada J. Mont L. et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991; 83(5):1649-59.
  13. Marill KA. deSouza IS. Nishijima DK. et al. Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Ann Emerg Med 2006; 47(3):217-24.
  14. Tomlinson DR. Cherian P. Betts TR. et al. Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment? Emergency Medicine Journal 2008; 25(1):15-8.
  15. Ho DS. Zecchin RP. Richards DA. et al. Double-blind trial of lignocaine versus sotalol for acute termination of spontaneous sustained ventricular tachycardia. Lancet 1994; 344(8914):18-23.
  16. Fengler BT. Brady WJ. Plautz CU. Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED. Am J Emerg Med 2007; 25(5):576-83.
  17. Di Biase L, MD, Walsh EP. Treatment of arrhythmias associated with the Wolff-Parkinson-White syndrome. UpToDate. Updated July 2022.
  18. Crozier I. Flecainide in the Wolff-Parkinson-White syndrome. American Journal of Cardiology 1992; 70(5):26A-32A.
  19. Burns E. Drugs Causing QT Prolongation. Life In The Fast Lane (LITFL). February 2021.

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