A fictional 66-year-old develops a broad-complex tachycardia with ongoing chest pain, pulmonary oedema and falling blood pressure.
Frame the danger first.
- Assess the patient before concentrating on rhythm classification: shock, syncope with severe hypotension, ischaemia and severe heart failure are life-threatening features.
- Treat sinus tachycardia by identifying its cause rather than trying to suppress the rate.
- Use QRS width and regularity to describe the rhythm while obtaining expert help.
Act, escalate, reassess.
- Call the resuscitation team, begin ABCDE assessment and monitor ECG, blood pressure and oxygen saturation.
- Follow the current Resuscitation Council UK/local tachyarrhythmia algorithm and prepare synchronised cardioversion when life-threatening features are attributable to the rhythm.
- Plan sedation or anaesthesia support for a conscious patient without delaying emergency treatment.
- Identify reversible causes and reassess after each intervention.
Red flags that change pace.
- Shock or syncope with severe/ongoing hypotension
- Myocardial ischaemia or severe heart failure with pulmonary oedema
- Immediately post-return of spontaneous circulation or persistent deterioration
What makes care less safe.
- Treating sinus tachycardia as a primary arrhythmia
- Delaying synchronised cardioversion in an unstable patient while pursuing detailed rhythm diagnosis
- Giving rhythm-specific drugs without checking QRS pattern, contraindications and expert guidance
Say the concern plainly.
Unstable tachyarrhythmia at [rate] with QRS [broad/narrow, regular/irregular] and adverse features [list]. Monitoring, reversible-cause assessment and algorithm treatment are [status]. I need immediate resuscitation/cardiology support.