Ventricular Tachycardia with a Palpable Pulse: Difference between revisions

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===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===
===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===


 
* [[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) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.
====STABLE AND SYMPTOMATIC:====
 
====STABLE AND SYMPTOMATIC: ====
* [[Antiarrhythmics|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics|LIDOCAINE]] DRIP @ 2 mg / minute;
* [[Antiarrhythmics|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics|LIDOCAINE]] DRIP @ 2 mg / minute;
* If NO response, repeat [[Antiarrhythmics|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 [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg/kg until maximum of 1.5 mg / kg administered.
* If NO response, repeat [[Antiarrhythmics|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 [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg/kg 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. '''''


====UNSTABLE:====
====UNSTABLE:====
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
{| class="wikitable"
* If IV established prior to patient becoming UNSTABLE, may administer [[Sedative Hypnotics|VERSED]] 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
|-
! 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 [[Antiarrhythmics|LIDOCAINE]].
* If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Antiarrhythmics|LIDOCAINE]].
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 200 Joules.
* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
* If NO response. [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.
* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
 
 
This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''


If the patient presents with one or more of the above UNSTABLE criteria, [[Defibrillation|DEFIBRILLATION]] should be administered to avoid delays associated with synchronization.
{| class="wikitable"
|-
! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
|}

Revision as of 17:53, 3 May 2012

Section 4 - CARDIAC

4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE

STABLE AND SYMPTOMATIC:

  • 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 boluses at 0.25 mg/kg 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.
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