Tachydysrhythmias
Description Emergency Treatment Referral ICD-10 code: R00.0 Refer to Adult and Paediatric Hospital Level STGs and EML for relevant guidance. DESCRIPTION Adults: tachydysrhythmias refer to a pulse rate > 150 beats/minute. Children: tachydysrhythmias refers to a pulse rate > normal range for age (see table below). EMERGENCY TREATMENT Assess ABC: Airway: ensure airway is open and clear.
ICD-10 code: R00.0
Refer to Adult and Paediatric Hospital Level STGs and EML for relevant guidance.
DESCRIPTION
Adults: tachydysrhythmias refer to a pulse rate > 150 beats/minute.
Children: tachydysrhythmias refers to a pulse rate > normal range for age (see table below).
EMERGENCY TREATMENT
Assess ABC:
- Airway: ensure airway is open and clear.
- Breathing: give oxygen to target pulse oximeter saturation of 94-98%.
- Circulation: assess peripheral perfusion, measure pulse and blood pressure.
Table 21.2: Child heart rate ranges
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Child Heart Rate Ranges for Age
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Age
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Normal Heart Rate Range (Beats/ Minute)
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Newborn to 3 months
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85–205
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3 months to 2 years
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100–190
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2 years to 10 years
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60–140
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> 10 years
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60–100
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- Supraventricular tachycardia is suspected in a child when the pulse rate > 180 beats/ minute in a child and > 220 beats/ minute in an infant.
- Attach ECG monitor, pulse oximeter and blood pressure cuff.
- Establish IV access.
- Print rhythm strip to confirm tachycardia, if possible do 12 lead ECG.
- Assess for signs of instability:
- Hypotension
- Altered mental status
- Chest pain
- Acute heart failure
- Signs of shock: cold clammy peripheries and weak pulses
Adult
If unstable:
- Synchronised cardioversion at 100 J.
- Consider analgesia and sedation if time permits.
If stable:
Assess QRS length on rhythm strip or 12 lead ECG:
- If QRS < 0.12 = Narrow complex tachycardia (supraventricular tachycardia):
- Attempt vagal stimulation:
- Modified valsalva manoeuvre.
- Ice water applied to face.
- Cough, breath holding.
- Carotid sinus massage (not in elderly or those with cardiac disease).
- If QRS > 0.12 = Wide complex tachycardia (ventricular tachycardia):
- Correct electrolyte disturbances.
- Consider toxins, overdoses.
Children
If unstable:
- Synchronised cardioversion at 0.5-1 J/kg initially (max 4 J/kg).
- Consider analgesia and sedation if time permits.
If stable:
Assess QRS length on rhythm strip or 12 lead ECG:
- If QRS < 0.08 = Narrow complex tachycardia (supraventricular tachycardia):
- Attempt vagal stimulation: Ice water applied to face
- If QRS > 0.08 = Wide complex tachycardia (ventricular tachycardia):
- Correct electrolyte disturbances.
- Consider toxins, poisoning, overdoses.
REFERRAL
Urgent
All patients: transfer with supportive care and accompanying skilled worker until care is taken over by doctor at receiving institution.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.1_October 2024
Chapter 21: Emergencies and Injuries