Ventricular Tachycardia with a Palpable Pulse: Difference between revisions
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* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM. | * [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM. | ||
====STABLE AND SYMPTOMATIC:==== | ====STABLE AND SYMPTOMATIC:==== | ||
* Administer [[ | * Administer [[Amiodarone|AMIODARONE]] 150 mg in 50 ml over 10 minutes. | ||
:'''OR''' | :'''OR''' | ||
* [[ | * [[Lidocaine|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Lidocaine|LIDOCAINE]] DRIP @ 2 mg / minute; | ||
**If NO response, repeat [[ | **If NO response, repeat [[Lidocaine|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 [[ | * In patients over age 70 or in those with known hepatic disease, administer [[Lidocaine|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.''''' | '''''Physician's Orders: If NO response, contact Medical Control for consult.''''' | ||
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*** If wide and irregular complexes – use defibrillation dose (not synchronized) | *** 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 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 [[ | * If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Lidocaine|LIDOCAINE]]. | ||
* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules. | * If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules. | ||
* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules. | * If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules. |
Latest revision as of 23:49, 23 April 2020
Section 4 - CARDIAC
4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE
- INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM.
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: |
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- 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)
- Initial recommended doses:
- 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. |
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