Examples by inFlow interactive Flowcharts
  • Assess using the ABCDE-approach
  • Give oxygen if appropriate and obtain IV-access
    • Monitor ECG, BP, SpO2, record 12-lead ECG
    • Identify and treat reversible causes (e.g electrolyte abnormalities)
    Adverse features?
    • Shock
    • Syncope
    • Myocardial is chaemia
    • Heart failure
    Synchronised DC Shock
    Up to 3 attempts
    Is QRS narrow (< 0.12s)?
    • Amiodarone 300 mg IV over 10 - 20 min and repeat shock
    • Follow with Amiodarone 900 mg over 24 h
    Broad QRS
    Is rhythm regular?
    Narrow QRS
    Is rhythm regular?
    Possibilities include:
    • AF with bundle branch block (treat as for narrow complex)
    • Pre-excited AF (consider amiodarone)
    • Polymorphic VT (e.g. torsade de pointes - give magnesium 2 g over 10 min)
    If ventricular tachycardia (or uncertain rhythm):
    • Amiodarone 300 mg IV over 20-60min; then 900 mg over 24 h
    If previously confirmed SVT with bundle branch block:
    • Give adenosine as for regular narrow complex tachycardia
    Probable atrial fibrillation
    Control rate with:
    • β-blocker or diltiazem
    • Consider diogoxin or amiodarone if evidence of heart failure
    • Use vagal manoeuvres
    • Adenosine 6 mg rapid IV bolus; if unsuccesful give 12 mg; if unsuccesful give 12 mg.
    • Monitor ECG continuously
    Sinus rhythm restored?
    Sinus rhythm restored
    Probable re-entry paroxysmal SVT:
    • Record 12-lead ECG in sinus rhythm
    • If recurs, give adenosine again & consider choice of anti-arrhythmic prophylaxis
    Sinus rhythm not restored
    Possible atrial flutter:
    • Control rate (e.g. β-blocker)