TACHYCARDIA WITH PULSE – STABLE
Inclusion Criteria: Adult patients who present with a palpable pulse rate greater than 150 bpm, and pediatric patients with a heart rate greater than normal for their age, and both of the following two criteria are met: 1) sinus tachycardia is NOT suspected, and 2) there are NO signs or symptoms of hypoperfusion (hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort or acute heart failure).
Basic Level
- Assess and support ABCs.
- Place the patient in a position of comfort.
- Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
- If chest pain/discomfort is present or develops, treat the pain under the CHEST PAIN Guidelines while continuing these guidelines.
- Once advanced level care arrives on scene, give report and transfer care.
Advanced Level
- Continuously monitor ECG and SpO2. Continuously monitor ETCO2 if the patient is hypotensive.
- Obtain a 12-Lead ECG and consult with BioTel, as needed. NOTE: 3-lead ECG monitoring is not a substitute for a 12-lead ECG.
- 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; for infants, HR greater than 220, and for children 1-8 years old, HR greater than 180 is most likely SVT, not sinus tachycardia.)
- Establish IV/IO access at a TKO rate or use a saline lock.
- STABLE PATIENT WITH NARROW-COMPLEX TACHYDYSRHYTHMIA (>>NOT Sinus Tachycardia!!<<)
If NO signs or symptoms of hypoperfusion are present or develop:
Adult
- Attempt Valsalva maneuver, if the QRS complex is narrow and the rhythm is regular.
- Administer adenosine:
- First dose: 12 mg RAPID IVP.
- Flush with 10 – 20 mL Normal Saline.
- May repeat once, if no conversion after 1 – 2 minutes.
- Flush with 10 – 20 mL Normal Saline.
- ECG monitor must run continuously during Valsalva maneuver, adenosine administration, and response.
Pediatric
- Consider vagal maneuver, if the QRS complex is narrow and the rhythm is regular.
- Contact BioTel and prepare for IV/IO access.
- BioTel may authorize adenosine administration:
- 0.1mg/kg RAPID IVP (maximum 6 mg).
- Flush with 5 – 10 mL Normal Saline.
- May repeat once at 0.2 mg/kg (maximum 12 mg).
- Flush with 5 – 10 mL Normal Saline.
- ECG monitor must run continuously during Valsalva maneuver, adenosine administration, and response.
- STABLE PATIENT WITH NON-SUSTAINED, WIDE-COMPLEX TACHYCARDIA (QRS at least 0.12 second)
If NO signs or symptoms of hypoperfusion are present or develop:
Adult and Pediatric
- Initiate transport and monitor closely, especially continuous ECG monitoring.
- Consider establishing IV/IO access at TKO rate.
- Prepare for clinical deterioration and the need for possible synchronized cardioversion.
- STABLE PATIENT WITH SUSTAINED, WIDE-COMPLEX TACHYCARDIA (QRS at least 0.12 second)
If NO signs or symptoms of hypoperfusion are present or develop:
Adult
- Consider amiodarone infusion – Contact BioTel.
Pediatric
- Contact BioTel.
- Prepare for:
- Possible IV/IO access for anti-arrhythmic or sedation administration; and/or
- Possible synchronized cardioversion.
- ECG monitor must run continuously before and during treatment and response.
- Initiate transport and closely monitor vital signs, ECG, SpO2 and ETCO2.
- For additional patent care considerations not covered under standing orders, consult BioTel.