Acute Management of Arrhythmia

  1. Tachyarrhythmia in a stable patient
    1. Run continuous Rhythm strip (preferably a three-lead or 12 lead ) ECG

During the conversion attempt

  1. Vagal maneuvers

Valsalva/Gag/Ice to face

(Avoid carotid & ocular massage and hypertension-producing drugs)

  1. Adenosine (Adenocard, 2 mg/vial x 3mg/ml= 6mg/vial) DRUG OF CHOICE
    • Start dose 50 μg/kg IV push(fastest bolus possible, follow immediately with saline flush)
    • Increase by 100 μg/kg/dose to maximum 500 μg/kg (Theophylline is antagonist; may need >> maximum dose)
  2. Verapamil is absolutely contraindicated in < age 12 months and relatively contraindicated in WPW syndrome.
  3. Obtain 12-lead ECG after conversion


  1. Tachyarrhythmia in an unstable patient
    1. Cardioversion
  2. Bradyarrhythmia in an unstable patient
    1. Isoprenaline 0.1 – 0.5 μg/kg/min
    2. Pacemaker
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