Sandbox/nct fire

First Initial Rapid Evaluation of Suspected Narrow Complex Tachycardia

Shown below is an algorithm for the First Initial Rapid Evaluation (FIRE) of suspected NCT

Identify cardinal signs and symptoms that increase the pretest probability of NCT ❑ Palpitations (Most common presentation) ❑ Tachycardia ❑ Hypotension ❑ Loss of consciousness ❑ Severe dyspnea

❑ Unstable patient

❑ Stable patient

If the rhythm isn't sinus: ❑ Urgent DC cardioversion

If the rhythm is sinus: ❑ Control the rate: ❑ IV metoprolol (2.5 to 5 mg over 2 minutes up to a maximum of 15 mg) ❑ Treat the underlying cause

Continue with the diagnostic approach

❑ Assess airway, breathing, and circulation (ABC) ❑ Administer oxygen if necessary