Part 7.3: Management of Symptomatic Bradycardia and Tachycardia

Abstract

Cardiac arrhythmias are a common cause of sudden death. ECG monitoring should be established as soon as possible for all patients who collapse suddenly or have symptoms of coronary ischemia or infarction. To avoid delay, apply adhesive electrodes with a conventional or automated external defibrillator (AED) or use the “quick-look” paddles feature on conventional defibrillators. For patients with acute coronary ischemia, the greatest risk for serious arrhythmias occurs during the first 4 hours after the onset of symptoms (see Part 8: “Stabilization of the Patient With Acute Coronary Syndromes”).1 The ECG and rhythm information should be interpreted within the context of total patient assessment. Errors in diagnosis and treatment are likely to occur if ACLS providers base treatment decisions solely on rhythm interpretation and neglect clinical evaluation. Providers must evaluate the patient’s symptoms and clinical signs, including ventilation, oxygenation, heart rate, blood pressure, and level of consciousness, and look for signs of inadequate organ perfusion. These guidelines emphasize the importance of clinical evaluation and highlight principles of therapy with algorithms that have been refined and streamlined since the 2000 edition of the guidelines.2 The principles of arrhythmia recognition and management in adults are as follows: