Perfusing Arrhythmias

Perfusing Arrhythmias
■ BLS algorithm, call for help, begin CPR if indicated. ■ Administer oxygen and attach monitor/defibrillator. ■ Search for and manage reversible causes (see above).
Bradycardia	All Unstable* Tachycardia
Stable (adequate perfusion): ■ Monitor and supportive care as needed.	*(CP, ↓ BP, SOB, or ALOC) Cardiovert: Immediate synchronized cardioversion.
Bradycardia	All Unstable* Tachycardia
Unstable, with poor perfusion (CP, ↓BP, SOB, or ALOC) ■ Pace: Prepare for transcutaneous pacing (TCP). Do not delay for second-degree type 2 or thirddegree AV block. ■ Atropine 0.5 mg IV every 3–5 min to a max of 3 mg. ■ Epinephrine 2–10 _g/min or Dopamine 2–20 ug/kg/min if TCP is ineffective or unavailable. ■ Prepare for transvenous pacing, treat reversible causes.	■ Monomorphic VT/A-fib: 100 J, 200 J, 300 J, 360 J. ■ Atrial flutter and SVT: May start with 50 J ■ Polymorphic VT: Unsynchronized with 360 J. Premedicate: Administer sedatives and analgesia whenever possible. Caution: If delays occur with synchronization and clinical situation is critical, go immediately to unsynchronized cardioversion at 360 J.