<--back to table of contents
 

 

Tachycardia, Narrow Complex

Inclusion Criteria: Patients who present with a palpable pulse rate greater than 150 and pediatric patients with a heart rate greater than normal for their age.

          Basic Level

  1. Assess and support ABCs.

  2. Place patient in a position of comfort. If evidence of shock, place the patient supine with the feet elevated.

  3. Administer oxygen as needed to maintain a SpO2 of at least 96%.

  4. If chest pain is present or develops, treat the pain under the Chest Pain guidelines while continuing these guidelines.

  5. Once advanced level care arrives on scene, give report and transfer care.


    Advanced Level

  6. Continuous cardiac monitoring. Use capnography if the patient is hypotensive. Obtain 12-Lead ECG and consult with BioTel, as needed. (12-lead acquisition MUST NOT delay care of the unstable patient.)

  7. Always attempt to rule out sinus tachycardia as a potential cause of the symptoms (220 minus the patient’s age [in years] is the upper limit of sinus tachycardia).

  8. Establish IV access at a TKO rate or use a saline lock. (IV initiation MUST NOT delay care of the unstable patient)


    FOR STABLE PATIENTS WITH A TACHYDYSRHYTHMIA (SINUS TACHYCARDIA NOT SUSPECTED )

  9. If NO signs or symptoms of hypoperfusion are present or develop:

    Adult

    • Attempt Valsalva maneuver, if the narrowcomplex tachycardia is regular in appearance
    • Administer adenosine followed immediately by 20 ml saline rapid IVP
      o    12 mg rapid IVP
      o    Repeat if no conversion in 1 or 2 minutes
    • ECG monitor must run continuously during Valsalva maneuver, adenosine administration, and response

    Pediatric

    • Contact BioTel


    FOR UNSTABLE PATIENTS WITH A TACHYDYSRHYTHMIA (SINUS TACHYCARDIA NOT SUSPECTED)

  10. If signs or symptoms of hypoperfusion are present or develop:

    Adult

    • Immediate synchronized cardioversion @ 70 J, 100 J, 200 J, 300 J, 360 J.
    • If conscious, sedate prior to cardioversion
      o    Diazepam in 2.5 mg – 5 mg increments slow IVP to a maximum of 10 mg, or
      o    Midazolam in 2.5 mg – 5 mg increments slow IVP (max 5 mg) or IN (max 10 mg)

    Pediatric

    • Contact BioTel
    NOTE: Individual departments may carry only one sedative; they are not required to carry both.

  11. Initiate transport and monitor closely.

  12. For additional patient care considerations not covered under standing orders, consult BioTel.

 

 

<--back to table of contents