Both supraventricular and ventricular tachycardia are frequently seen in the critically ill. If the patient is hemodynamically stable, a 12-lead ECG should be obtained initially and compared with a baseline recording. A supraventricular tachycardia is present if the QRS complex is narrow (less than 0.12 s). If it is 0.12 s or more, ventricular tachycardia must be differentiated from supraventricular tachycardia with aberrancy, provided that an underlying bundle branch block is not present. The ECG should then be scanned for P waves (best seen in leads II and V1) and their relationship to the QRS complex. This relationship, together with the configuration of the P wave, may provide useful information, as may Lewis leads, i.e. placing the right and left arm leads along the sternal borders and monitoring lead I.

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