Tachycardia
Tachycardia in theatre is often due to inadequate depth of anaesthesia / analgesia or alternatively a reflex to hypotension. Tachycardia should not be treated as an isolated variable: remember to tailor treatment to the patient and the situation. Follow the full steps to exclude a serious underlying problem.
If no pulse, delegate one person (minimum) to chest compressions and → 2-1 Cardiac arrest.
If hypotension worsening or impending arrest, consider electrical cardioversion (Box D).
Stimulation with inadequate depth.
Consider drug error.
Also consider: central line/wire; hypovolaemia; primary cardiac arrhythmia; myocardial infarction; electrolyte disturbance; local anaesthetic toxicity (→ 3-10); sepsis (→ 3-14); circulatory embolus, gas/fat/amniotic (→ 3-5); anaphylaxis (→ 3-1); malignant hyperthermia crisis (→ 3-8)
Fluid bolus 10 ml.kg⁻¹ (adult 250 ml)
Magnesium 50 mg.kg⁻¹ (adult 2 g) over >10 min, max conc. 200 mg.ml⁻¹
Amiodarone 5 mg.kg⁻¹ (adult 300 mg) over >3 min, NOT in polymorphic VT
Labetalol 0.5 mg.kg⁻¹ (adult 25–50 mg), repeat when necessary
Esmolol 0.5 mg.kg⁻¹ (adult 25–50 mg)
Adenosine 0.1 to 0.5 mg.kg⁻¹ (adult 3 to 18 mg) – for SVT
Attach pads and ECG from defibrillator.
Ensure adequate depth / sedation / analgesia for cardioversion.
Engage synchronisation and check for sync spikes on R-waves.
Start with 1 J.kg⁻¹ (adult 50–100 J) biphasic.
Remember to hold shock button until sync shock delivered.