Re-entrant SVT If you cannot spot flutter or P waves that precede the QRS complex then you can safely assume a re-entrant SVT. Flecainide can paradoxically lead to an increase in the ventricular rate by causing 1:1 conduction and is best avoided Pharmacological cardioversion is generally less effective than in atrial fibrillation. If symptoms have been present <48 hours than electrical cardioversion is probably the treatment of choice. Treatment is broadly the same as for atrial fibrillation (see AF later). Look carefully for flutter waves in all leads but especially in leads V1 and II. Look at the rate and suspect flutter if it is 140-160 and stays more or less constant.Be wary of discharging a patient with an unresolved tachycardia. Direct treatment at the underlying cause (e.g. Remember that very fast rates are unlikely in sinus rhythm maximum heart rate = 220-age is a helpful formula. These can be difficult to see at faster heart rates. Sinus tachycardia: Scrutinise the ECG carefully for P waves. Tips on Differentiating Between The Different Rhythms Three most common causes of a regular narrow complex tachycardia: These questions allow you to subdivide the rhythms into four categories (regular narrow complex/ irregular narrow complex/ regular broad complex/ irregular broad complex). Is the tachycardia regular or irregular?.Is the tachycardia narrow (QRS 120 ms)?.hypovolaemia or electrolyte abnormalities Correcting potential underlying causes e.g.Changing pad position to anterior/posterior.If the patient is unstable and you deliver three shocks to them without success, administer amiodarone 300mg IV over 10-20 minutes and repeat synchronised DC shock (ensure maximum recommended shock level is given). Initial shock of 120-150J, with stepwise increases in electricity for subsequent shocks, for ventricular tachycardia.Initial shock of 70-120J, with stepwise increases in electricity for subsequent shocks, for atrial flutter or supraventricular tachycardia.
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