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

  1. Assess and support ABCs.
  2. Place the patient in a position of comfort.
  3. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
  4. If chest pain/discomfort 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

  1. Continuously monitor ECG and SpO2.  Continuously monitor ETCO2 if the patient is hypotensive. 
  2. 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.
  3. 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.)
  4. Establish IV/IO access at a TKO rate or use a saline lock.

  5. STABLE PATIENT WITH NARROW-COMPLEX TACHYDYSRHYTHMIA (>>NOT Sinus Tachycardia!!<<)

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

Adult

Pediatric

  1. 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

  1. 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

Pediatric

  1. Initiate transport and closely monitor vital signs, ECG, SpO2 and ETCO2.
  2. For additional patent care considerations not covered under standing orders, consult BioTel.