Emergencies

Symptomatic bradycardia (HR <60/min or significantly diminished from baseline):

Options include: atropine 0.5 mg IV q3-5 min up to max 3 mg total; dopamine 2-10 mcg/kg/min; epinephrine 2-10 mcg/min; transcutaneous pacing

Symptomatic unstable tachycardia (ventricular rate >150/min; for ventricular tachycardia, paroxysmal supraventricular tachycardia, and atrial flutter):

Open airway; chest compressions as necessary
Positive-pressure ventilation
Synchronized cardioversion 100, 200, 300, 360 J, sequentially

Stable narrow complex tachycardia (narrow QRS [<0.12 sec] and ventricular rate >150/min; stable, no serious symptoms):

Regular rhythm: vagal maneuvers, adenosine 6 mg rapid IV push over 1-3 sees
Irregular rhythm: possible atrial fibrillation, atrial flutter, or multifocal atiral tachycardia; consult medicine/cardiology, control rate with diltiazem, betablockers (use with caution)

Wide complex (regular) tachycardia (wide QRS [>0.12 sec]) Ventricular tachycardia or uncertain rhythm:

Amiodarone 150 mg IV over 10 mins, repeat prn to a max of 2.2 gm over 24 hrs; prepare for elective synchronized cardioversion Supraventricular tachycardia with aberrant conduction:
Adenosine 6 mg rapid IV push over 1-3 secs, followed by adenosine 12 mg IV push over 1-3 secs after 1-2 mins (may repeat once)

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