2-5 STABLE TACHYCARDIA

Any patient requiring ACLS care should have an ALS intercept if logistically possible

EMR - Emergency Medical Responder

1. Begin initial medical care
2. Administer oxygen
3. Assist ventilations if RR < 8 or > 35
4. Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow shock protocol
5. Call for ALS intercept

EMT- Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assure ALS intercept is en route
2. Transport as early as possible
3. Reassess VS often during transport
4. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed)
5. Perform 12-lead ECG (if trained) as indicated

CONTACT MEDICAL CONTROL

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Start IV access en route, NS TKO (do not delay transport)
2. Administer NS fluid bolus, as directed

CONTACT MEDICAL CONTROL

Intermediate   Perform/Confirm All Above Interventions

1. Attach cardiac monitor if not already done, confirm rhythm via 12 lead ECG
2. Observation and transport for asymptomatic tachycardia
3. Narrow Complex Tachycardia (SVT) HR > 150
   1. Perform vagal maneuvers
   2. Give adenosine (Adenocard) rapid IV push followed by rapid saline flush, as near to IV site as possible
      1. Give 6 mg & assess underlying rhythm; Transport without more adenosine if underlying rhythm is junctional, ectopic or  multifocal atrial tachycardia
      2. Give 12 mg if refractory SVT; May repeat 12 mg if still refractory SVT
      3. Expedite transport if adenosine (Adenocard) is unsuccessful
   3. Reassess VS and rhythm frequently
   4. CONTACT MEDICAL CONTROL if:
      1. Known history of Wolff-Parkinson-White syndrome
      2. HR < 150
      3. Adenosine (Adenocard) was unsuccessful
4. For Wide Complex Tachycardia (QRS > 0.12 sec)
   1. Assess for patient stability.
   2. If the patient is UNSTABLE (has a systolic BP less than 90, altered mental status, signs of shock, chest pain or acute heart failure):
      1. Perform synchronized cardioversion.
   3. If the patient is STABLE:
      1. CONTACT MEDICAL CONTROL
      2. Administer amiodarone (Cordarone) 150 mg slow IV/IO over 10 min; May repeat (evaluate rhythm very closely, amiodarone  may be contraindicated for torsades de point) -OR-
      3. Administer lidocaine 0.5 mg/kg IV/IO over 2 minutes, may repeat in 5-10 minutes

Paramedic   Perform/Confirm All Above Interventions

CONTACT MEDICAL CONTROL

1. For Torsades de Pointe, administer magnesium sulfate 1 gram over 60 minutes