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Option 1: Unstable tachycardia

Last updated: May 1, 2025

Reading the signstoggle arrow icon

The patient has signs of unstable tachycardia. She is hypotensive and confused. The nurse states that the patient's condition has deteriorated since they sent the page a few minutes ago. You confirm that the patient is full code and ask the nurse to call the rapid response team. With more help on the way, your team begins stabilizing the patient. The senior resident and attending allow you to take the lead.

Question: What do you do next?

Make your choice, then click on the explanation bubble to reveal the answer.

The first step when assessing a decompensating patient is always an ABCDE survey.

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Initial management approachtoggle arrow icon

You perform an ABCDE survey and determine that the patient has a pulse. What comes next?

Question: What are your initial steps for managing this patient's unstable tachycardia?

Do the following steps concurrently. Click on the explanation bubbles for more information.

Preparation is key. For patients with tachycardia, ensure speedy delivery of potentially necessary equipment (e.g., defibrillator, intubation equipment) to the bedside, even if you don't know whether you'll need to use it.

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Practicetoggle arrow icon

While all patients with instability due to tachycardia will require immediate electrical cardioversion regardless of the underlying rhythm, it is still helpful to know the rhythm. Knowing the rhythm will help you determine management once the patient is stabilized.

ECG interpretation

Take some time to practice interpreting the cardiac rhythm for the following ECGs.

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Dive deepertoggle arrow icon

Your stepwise approach to management allows you to quickly stabilize the patient, and your senior resident, attending, and medical students all seem thoroughly satisfied . For a detailed dive into the appropriate approach to the tachycardic patient, see “Management of tachycardia.”

Related resources

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Continue the adventuretoggle arrow icon

Want to explore the other scenario? Jump over to “Option 2: Stable tachycardia.” You can also return to the main module; see “Heart in overdrive wrap-up.”

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