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ACLS Tachycardia with Pulse Algorithm (AHA 2025)

ACLS Tachycardia with Pulse Algorithm (AHA 2025): Tachycardia with Pulse → Hemodynamically Unstable? → Synchronized Cardioversion → Rhythm Converts? → S...

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Tachycardia with Pulse

    HR >150 bpm with symptoms

    1. Decision

      Hemodynamically Unstable?

      Signs of instability

      • Hypotension
      • Altered mental status
      • Signs of shock
      • Chest pain
      • Acute heart failure

      If Yes:

      1. Action

        Synchronized Cardioversion

        IMMEDIATE if unstable

        • Sedate if possible
        • Use device-recommended energy
        • Sync mode ON
        1. Decision

          Rhythm Converts?

          If Yes:

          1. Outcome

            SVT Confirmed

            Maintenance therapy, EP referral

          If No:

          1. Outcome

            Cardiology/EP Consult

            Further management

      If No:

      1. Decision

        QRS Width?

        Determine rhythm type

        1. Action

          Narrow Regular

          Likely SVT

          • 1. Vagal maneuvers
          • 2. Adenosine 6mg rapid IV
          • 3. Adenosine 12mg if no response
          • 4. Beta-blocker or CCB
          1. Action

            Narrow Irregular

            AFib, AFlutter, MAT

            • Rate control (BB, CCB, digoxin)
            • Anticoagulation consideration
            • Avoid adenosine
          2. Warning

            WPW/Pre-excitation WARNING

            AVOID these drugs

            • Adenosine
            • Digoxin
            • Calcium channel blockers
            • Beta-blockers
            • IV Amiodarone
        2. Action

          Wide Regular

          VT or SVT with aberrancy

          • If VT or uncertain: Amiodarone 150mg/10min
          • Adenosine if SVT suspected (Class IIb)
          • Procainamide or Sotalol alternatives
          1. Warning

            Wide Irregular

            DANGER - Expert consult

            • If polymorphic VT/Torsades: DEFIBRILLATE (not sync)
            • Pre-excited AF: AVOID adenosine, CCB, BB, digoxin
            • Use procainamide or cardioversion

Guideline Source

2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Assumes adult with pulse
  • Cardioversion energies: use device manufacturer guidance
  • WPW/pre-excitation requires special considerations

Contraindicated Populations

pediatric

Applicable Regions

USEU

EU: ERC guidelines similar approach

US: AHA 2025 - specific energies deferred to device manufacturer

Version 1Next review: 2030-10-01

Frequently Asked Questions

What is the ACLS Tachycardia with Pulse Algorithm (AHA 2025)?

The ACLS Tachycardia with Pulse Algorithm (AHA 2025) is a emergency clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support.

What guideline is the ACLS Tachycardia with Pulse Algorithm (AHA 2025) based on?

This algorithm is based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support (DOI: 10.1161/CIR.0000000000001376).

What are the limitations of the ACLS Tachycardia with Pulse Algorithm (AHA 2025)?

Known limitations include: Assumes adult with pulse; Cardioversion energies: use device manufacturer guidance; WPW/pre-excitation requires special considerations. Individual patient factors may require deviation from these recommendations.

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