• Tachycardia, either supraventricular or ventricular,
with regular ventricular response with mild to moderate hypotension.
• Mechanisms of supraventricular tachycardia include the following:
• Atrial reentry tachycardia.
• Reciprocating tachycardia utilizing an accessory connection.
• Atrial flutter.
• Atrioventricular nodal reentry tachycardia.
• Cardioversion: Can be performed using medications, electrical pacing, or electrical direct current shock synchronized to QRS complex to correct an abnormal rapid cardiac rhythm.
• Benefits of cardioversion are restoration of a sinus or slower rhythm, improving cardiac output and function, and decreasing the risk of thromboembolism, cardiac dysfunction, and sudden death associated with the tachycardia.
• The most effective treatment for ventricular
fibrillation and pulseless ventricular tachycardia (Table
• Its effectiveness diminishes rapidly over time; therefore, early
defibrillation is recommended in patients who have suffered cardiac
• Atrial fibrillation.
• Supraventricular tachycardia with rapid conduction via an accessory
• Ventricular fibrillation.
• Torsades de pointes.
|• Defibrillation: Uses electrical energy delivered transthoracically, nonsynchronously, and in a random fashion during the cardiac cycle to correct a very rapid rhythm.|
Table 7–1. Treating tachycardia.
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Table 7–1. Treating tachycardia.
|Narrow QRS complex||Sinus tachycardia||Treat underlying cause|
|Narrow QRS complex||Supraventricular tachycardia|
|Wide QRS complex|
SVT with aberrant
SVT with antegrade conduction over an accessory connection
Very rapid atrial or ventricular tachycardia
Atrial or ventricular
Torsades de pointes
• Cardioversion of a rhythm known to be automatic
in origin is not indicated.
• Digoxin toxicity-induced arrhythmia.
• Elective cardioversion of a hemodynamically stable patient with
a known atrial thrombus; however, the likelihood of impending cardiovascular
compromise can outweigh the risk of thromboembolism.
• Repeated cardioversion of a rhythm where the predisposing cause
is not eliminated.
• Skin electrode patches, wires to connect to defibrillator.
• Heart rhythm monitor.
• Equipment to protect the airway as well as resuscitation medications
to support blood pressure.
• Do not delay cardioversion or defibrillation in a hemodynamically
unstable patient while waiting for additional monitoring equipment
• Chest wall lesions.
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