Student learning toolCreated by: Champsedine Arevalo, MAN, RN, EMT
← Back to algorithms

Adult Tachycardia (with pulse)

HR ≥ 150 with symptoms. Stable → rhythm-based drugs. Unstable → cardioversion.

START
HR ≥ 150 with pulse
ACTION
ABCs, O₂ if hypoxic, IV, monitor, 12-lead ECG
DECIDE
Unstable?
Hypotension, altered LOC, shock, chest pain, acute heart failure.
YesSynchronized cardioversion
No — stableQRS narrow (< 120 ms)?
SHOCK
Synchronized cardioversion
Narrow regular: 50–100 J. Narrow irregular (AFib): 120–200 J. Wide regular: 100 J. Sedate if awake.
DECIDE
QRS narrow (< 120 ms)?
NarrowVagal maneuvers
WideAmiodarone 150 mg over 10 min
ACTION
Vagal maneuvers
Valsalva, carotid massage.
DRUG
Adenosine 6 mg rapid IV push
Follow with 20 mL flush. If no conversion, repeat 12 mg. Beta-blocker/CCB if AF/flutter.
DRUG
Amiodarone 150 mg over 10 min
Or procainamide 20–50 mg/min. Sotalol alternative. Expert consult.