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Tachycardia, Wide Complex

Inclusion Criteria: Heart rate greater than 150 bpm with sustained or non-sustained wide complex tachycardia.

          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/develops, treat using 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. Establish IV access at TKO rate or use saline lock. (IV initiation MUST NOT delay care of unstable patient)


    FOR STABLE PATIENTS WITH A NON-SUSTAINED WIDE COMPLEX TACHYCARDI A

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

    Adult

    • Initiate transport and monitor closely

    Pediatric

    • Initiate transport and monitor closely


    FOR STABLE PATIENTS WITH A SUSTAINED WIDE-COMPLEX TACHYCARDIA

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

    Adult

    • Administer lidocaine 1mg/kg - 1.5 mg/kg IVP

    Pediatric

    • Contact BioTel



    FOR UNSTABLE PATIENTS WITH A WIDE-COMPLEX TACHYCARDIA

  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 the patient is conscious, sedate prior to cardioversion attempt
      o    Diazepam, 2.5 mg – 5 mg slow IVP to a maximum of 10 mg, or
      o    Midazolam, 2.5 mg – 5 mg slow IVP (max 5 mg) or IN (max 10 mg)
    • Following cardioversion, administer Lidocaine 1 mg/kg - 1.5mg/kg IVP
      o    If wide complex tachycardia could be Torsades be Pointes, add 2 grams magnesium sulfate to 250 ml normal saline
      bag and infuse IV piggyback over 6 - 10 minutes
    • BioTel authorization required if dialysis patient

    Pediatric

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


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

 

 

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