Protocol for treating stable and symptomatic patients with tachycardia?

• A. Immediate defibrillation
• B. Consider and treat the underlying cause
• C. High-dose epinephrine
• D. Surgical intervention

Answer: (B)

When handling a stable but symptomatic tachycardia, the priority is to identify and treat underlying or reversible causes rather than jumping to aggressive rhythm correction. Start with a quick assessment to determine if the patient is truly stable and then look for triggers such as low oxygen levels, myocardial ischemia or infarction, electrolyte disturbances (like potassium or magnesium abnormalities), dehydration or fever, pain, anxiety, or drug/toxin effects. By correcting these factors, the heart rate often normalizes and symptoms improve.

In addition to addressing the underlying cause, manage the rhythm itself in a way appropriate to stability. If the rhythm is a narrow complex and the patient remains comfortable and stable, vagal maneuvers can be tried, and medications that slow the heart rate (like certain beta-blockers or calcium channel blockers) may be used if there are no contraindications. If the patient becomes unstable or does not respond to initial measures, synchronized cardioversion is considered. Immediate defibrillation is reserved for unstable patients or rhythms that are pulseless, not for stable tachycardia. Epinephrine at high doses isn’t part of routine tachycardia management, and surgical intervention isn’t indicated for stable tachycardia.