Facebook-f Twitter Whatsapp Envelope
Adult Tachycardia with a Pulse (ACLS): Recognition, Cardioversion, Adenosine & Antiarrhythmics
ACLS • Cardiology • Educational

Adult Tachycardia with a Pulse — Fast Algorithm Guide

Recognize unstable tachyarrhythmia quickly and act: synchronized cardioversion for instability, adenosine for regular narrow complexes, and antiarrhythmic infusions for stable wide-QRS rhythms—while searching for causes.

Visit Main Website Bradycardia

Educational content only—follow current guidelines and local protocols; consult a licensed clinician.

In this guide:
Assess & Initial Steps Unstable vs Stable Wide-QRS Path Narrow-QRS Path Key Doses Cited Keywords

1) Assess Appropriateness & Start Basics

  • Heart rate typically ≥ 150/min if tachyarrhythmia.
  • Maintain airway and support breathing; give oxygen if hypoxemic.
  • Cardiac monitor to identify rhythm; monitor BP and oximetry; establish IV access.
  • Obtain a 12-lead ECG if available (do not delay urgent treatment).

2) Is the Patient Unstable?

Unstable features from tachyarrhythmia include:

  • Hypotension
  • Acutely altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute heart failure
If any are present ➜ perform synchronized cardioversion. Consider sedation. If regular narrow complex, adenosine may be considered.

3) Stable Wide-QRS Tachycardia (QRS ≥ 0.12 s)

What to Consider

  • Adenosine only if the rhythm is regular and monomorphic.
  • Antiarrhythmic infusion (see doses).
  • Expert consultation.

If Refractory

  • Re-evaluate the underlying cause.
  • Increase energy for next cardioversion attempt if needed.
  • Add an antiarrhythmic drug and obtain expert help.

4) Regular Narrow-QRS Tachycardia

  • Try vagal maneuvers.
  • Give adenosine if regular.
  • Consider a beta-blocker or calcium-channel blocker.
  • Seek expert consultation as needed.

Key Doses & Infusions

Adenosine (IV)

  • First dose: 6 mg rapid IV push, then flush.
  • Second dose: 12 mg if required.

Works best for regular narrow-complex SVT.

Antiarrhythmic Infusions (Stable Wide-QRS)

  • Procainamide: 20–50 mg/min until rhythm suppressed, hypotension/QRS ↑ >50%, or max 17 mg/kg; maintenance 1–4 mg/min. Avoid in prolonged QT or CHF.
  • Amiodarone: 150 mg over 10 min; repeat if VT recurs, then maintenance 1 mg/min for first 6 hours.
  • Sotalol: 100 mg (≈1.5 mg/kg) over 5 min. Avoid with prolonged QT.

Synchronized Cardioversion

  • Use your device’s recommended energy; sedate when feasible.
  • For refractory cases, escalate energy and add antiarrhythmic support.

Exact energy levels and drug choices should follow your local protocols and device guidance.

Cited Keywords & Referral Links

Each keyword links to the main website or a related post on gyathshammha.com.

Tachycardia Synchronized cardioversion Adenosine Procainamide Amiodarone Sotalol Vagal maneuvers Beta-blocker Calcium-channel blocker 12-lead ECG Related education post

Bottom line

Unstable ➜ cardiovert. Stable wide-QRS ➜ consider adenosine (if regular/monomorphic) or antiarrhythmic infusion with expert help. Narrow-QRS ➜ vagal maneuvers, adenosine, then rate-control agents. Treat causes and keep reassessing.

This guide summarizes common teaching points and is not a substitute for current clinical guidelines or medical advice.

© • Adult Tachycardia with a Pulse • gyathshammha.com (no black backgrounds)