Use this quick-reference guide to recognise, treat and hand over Tachycardias & Bradycardias on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Unstable
Low BP · altered · shock
Ischemic pain · heart failure
📌 Fast
Unstable → synchronized cardioversion
Stable narrow regular → vagal, then adenosine
Wide → treat as VT
📌 Slow
Atropine first
Then pacing or infusion
Type II / third-degree → pads on
📌 No Pulse
Arrest algorithm · defibrillate
📚 Tachycardias & Bradycardias — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Rate disorders are managed by one question first: is the patient stable? Signs of poor perfusion caused by the rhythm drive electrical therapy; a stable patient allows time for a 12-lead and medication. The exam tests the fork, not the doses.
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Key points
Understand these first
Unstable means hypotension, altered mental status, signs of shock, ischemic chest pain or acute heart failure.
Unstable tachycardia with a pulse: synchronized cardioversion.
Stable narrow regular tachycardia: vagal maneuvers, then adenosine.
Symptomatic bradycardia: atropine first; if ineffective, transcutaneous pacing or a chronotropic infusion.
Sinus tachycardia is a response, not a disease — treat the cause (fever, pain, bleeding, hypoxia).
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Treatment priorities
What to do, in order
Decide stable versus unstable before choosing any therapy.
Get a 12-lead in the stable patient — width and regularity pick the path.
A pulseless rhythm goes to the arrest algorithm: defibrillate, never synchronize.
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Red flags — report now
Escalate immediately
Bradycardia with altered mental status or hypotension
Wide-complex tachycardia — treat as VT
Second-degree type II or third-degree block
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Patient teaching
What patients must know
Sinus tachycardia rarely exceeds 220 minus the age; a fixed rate near 150 suggests flutter or SVT.
Pacing: confirm electrical capture on the monitor and mechanical capture by a pulse.
❓ Tachycardias & Bradycardias: NREMT FAQs
What are the priority actions for Tachycardias & Bradycardias in the field?
Decide stable versus unstable before choosing any therapy. Get a 12-lead in the stable patient — width and regularity pick the path. A pulseless rhythm goes to the arrest algorithm: defibrillate, never synchronize.
What findings in Tachycardias & Bradycardias change your plan or your transport decision?
Bradycardia with altered mental status or hypotension. Wide-complex tachycardia — treat as VT. Second-degree type II or third-degree block.
What do I need to know about Tachycardias & Bradycardias for the NREMT?
Unstable means hypotension, altered mental status, signs of shock, ischemic chest pain or acute heart failure. Unstable tachycardia with a pulse: synchronized cardioversion. Stable narrow regular tachycardia: vagal maneuvers, then adenosine. Symptomatic bradycardia: atropine first; if ineffective, transcutaneous pacing or a chronotropic infusion.
What should the crew communicate or document for Tachycardias & Bradycardias?
Sinus tachycardia rarely exceeds 220 minus the age; a fixed rate near 150 suggests flutter or SVT. Pacing: confirm electrical capture on the monitor and mechanical capture by a pulse.
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Quick Tip
Unstable means hypotension, altered mental status, signs of shock, ischemic chest pain or acute heart failure.