Tachycardia and its ACLS AlgorithmTachycardia/tachyarrhythmia is defined as a rhythm with a heart rate greater than 100 bpm.An unstable tachycardia exists when cardiac output is reduced to the point of causing serious signs and symptoms.Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA, altered mental status, weakness, fatigue, and syncopeOne important question you may want to ask is: Are the symptoms being caused by the tachycardia? If the symptoms are being caused by the tachycardia treat the tachycardia.There are many causes of both stable and unstable tachycardia and appropriate treatment within the ACLS framework requires identification of causative factors. Before initiating invasive interventions, reversible causes should be identified and treated.CausesThe most common causes of tachycardia that should be treated outside of the ACLS tachycardia algorithm are dehydration, hypoxia, fever, and sepsis. There may be other contributing causes and review of theHs and Tsof ACLS should take place as needed.Administration of OXYGEN and NORMAL SALINE are of primary importance for the treatment of causative factors of sinus tachycardia and should be considered prior to ACLS intervention.Once these causative factors have been ruled out or treated, invasive treatment using the ACLS tachycardia algorithm should be implemented.Associated RhythmsThere are several rhythms that are frequently associated with stable and unstable tachycardia these rhythms include: Atrial fibrillation Atrial flutter Supraventricular tachycardia (SVT) Monomorphic VT Polymorphic VT Wide-complex tachycardia of uncertain type

The fist question that should be asked when initiating the ACLS tachycardia algorithm is: Is the patient stable or unstable? The answer to this question will determine which path of the tachycardia algorithm is executed.Patients withunstable tachycardiashould be treated immediately withsynchronized cardioversion. If a pulseless tachycardia is present patients should be treated using the pulseless arrest algorithm.Patients withstable tachycardiaare treated based upon whether they have a narrow or wide QRS complex. The following flow diagram shows the treatment regimen for stable tachycardia with narrow and wide QRS complex. Stable (narrow QRS complex) vagal maneuvers adenosine (if regular) beta-blocker/calcium channel blocker get an expert Stable (wide/regular/monomorphic) adenosine consider antiarrhythmic infusion get an expert

Bradycardia Algorithm Review(includes 2010 AHA Guideline Update)The major ECG rhythms classified as bradycardia include:Sinus BradycardiaFirst-degree AV blockSecond-degree AV blockType I Wenckenbach/Mobitz IType II Mobitz IIThird-degree AV block complete block(See theECG Interpretation sectionfor images and more detailed information on rhythms)Bradycardia vs. Symptomatic BradycardiaBradycardia is defined as any rhythm disorder with a heart rate less than 60 beats per minute. (Typically it will be