Ventricular Tachycardia with a Palpable Pulse

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Section 4 - CARDIAC

4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE

STABLE AND SYMPTOMATIC:

  • Administer AMIODARONE 150 mg in 50 ml over 10 minutes.
OR
  • LIDOCAINE 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start LIDOCAINE DRIP @ 2 mg / minute;
    • If NO response, repeat LIDOCAINE 0.5 mg/kg IVP until maximum of 3 mg/kg administered.
  • In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE at a full loading dose or until maximum of 1.5 mg/kg administered.

Physician's Orders: If NO response, contact Medical Control for consult.

UNSTABLE:

Definition of Unstable: Persistent Wide Complex Tachyarrhythmia causing:
  • Hypotension or signs of decreased tissue perfusion
  • Significant dyspnea or significant compromise of the airway
  • Acute mental status change
  • Signs/symptoms of shock
  • Acute heart failure
  • Ischemic chest discomfort
  • SYNCHRONIZED CARDIOVERSION
    • Initial recommended doses:
      • If narrow and regular complexes 50-100 Joules biphasic
      • If narrow and irregular complexes 120-200 Joules biphasic
      • If wide and regular complexes 100 Joules biphasic
      • If wide and irregular complexes – use defibrillation dose (not synchronized)
  • If IV established prior to patient becoming UNSTABLE, may administer VERSED 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
  • If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of LIDOCAINE.
  • If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
  • If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.
DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.