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Tachydysrhythmias, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Any disturbance of the heart's rhythm resulting in a rate >100 bpm

  • Sinus tachycardia:

    • Narrow complex regular rhythm at a rate of 100–150 bpm

    • Max. rate typically 220 minus age

    • Function...

Diagnosis

Signs and Symptoms

  • Asymptomatic

  • Palpitations

  • Lightheadedness

  • Dyspnea

  • Diaphoresis

  • Dizziness

  • Weakness

  • Chest discomfort

  • Angina

  • Syncope

  • Prominent neck veins

  • Signs of instability:

    • Hypotension

    • Pulmonary edema

    • Ch...

Treatment

Pre-Hospital

Cardiopulmonary resuscitation if pulseless 

Initial Stabilization/Therapy

  • IV access

  • Oxygen

  • Cardiac monitor

  • Determine rhythm

Ed Treatment/Procedures

  • Irregular narrow complex (A fib):

    • Rate...

Follow-Up

Disposition

Admission Criteria

  • VT or VF

  • Possible cardiac ischemic event

  • Persistent SVT

  • Underlying metabolic abnormalities

Discharge Criteria

Terminated supraventricular rhythm without organ hypoper...

Pearls and Pitfalls

  • Always suspect a ventricular rhythm with a wide complex rhythm, especially in the older patient.

  • Antidysrhythmic administration may increase success rate of cardioversion.

  • Rapid, uni...

Additional Reading

  • Anderson  BR, Vetter  VL. Arrhythmogenic causes of chest pain in children. Pediatr Clin North Am.  2010;57:1305–1329.

  • Hood  RE, Shorofsky  SR. Management of arrhythmias in the e...

Codes

ICD9

  • 427.0 Paroxysmal supraventricular tachycardia

  • 427.1 Paroxysmal ventricular tachycardia

  • 785.0 Tachycardia, unspecified

  • 427.31 Atrial fibrillation

  • 427.32 Atrial flutter

  • 427.89 Other specified cardi...

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