Cardiovascular Medicine Book

Approach

Atrial Fibrillation

Bradycardia

Information Resources

Miscellaneous

Symptoms

Tachycardia

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Examination Chapter related topics

Myocardial Disorders Chapter related topics

Obstetrics Chapter related topics

Pericardial Disorders Chapter related topics

Pharmacology Chapter related topics

Procedure Chapter related topics

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Ventricular Tachycardia Management in the Adult

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  1. See Also
    1. Guidelines 2000 CPR and Emergency Cardiovascular Care
  2. Approach
    1. No pulse
      1. Treat as Pulseless Ventricular Tachycardia
    2. Unstable
      1. Treat as Unstable Ventricular Tachycardia
      2. Administer Synchronized Cardioversion
    3. Stable
      1. Assess QRS Complex morphology
      2. Treat per protocols below
        1. Monomorphic Ventricular Tachycardia
        2. Polymorphic Ventricular Tachycardia
  3. Monomorphic Ventricular Tachycardia
    1. Normal Cardiac Function
      1. Medications: First line
        1. Procainamide 20-30 mg/min to max total 17 mg/kg
        2. Sotalol
      2. Medications: Second line
        1. Amiodarone 150 mg IV bolus over 10 minutes
        2. Lidocaine 0.5 to 0.75 mg/kg IV push
        3. Administer Synchronized Cardioversion
    2. Reduced cardiac function with poor ejection fraction
      1. Amiodarone 150 mg IV bolus over 10 minutes
      2. Lidocaine 0.5 to 0.75 mg/kg IV push
      3. Administer Synchronized Cardioversion
  4. Polymorphic Ventricular Tachycardia
    1. Normal baseline QT Interval
      1. General Measures
        1. Treat Myocardial Ischemia
        2. Correct electrolyte disturbance
      2. Medications
        1. Beta Blocker
        2. Amiodarone 150 mg IV bolus over 10 minutes
        3. Lidocaine 0.5 to 0.75 mg/kg IV push
        4. Procainamide 20-30 mg/min to max total 17 mg/kg
        5. Sotalol
        6. Administer Synchronized Cardioversion
    2. Prolonged baseline QT Interval (torsades de pointes)
      1. General Measures
        1. Correct electrolyte disturbance
      2. Medications
        1. Magnesium Sulfate
        2. Overdrive cardiac pacing
        3. Isoproterenol
        4. Phenytoin
        5. Lidocaine 0.5 to 0.75 mg/kg IV push
  5. References
    1. (2000) Circulation, 102(Suppl I):86-9
    2. http://www.circulationaha.org

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