Tachycardias – Wide Complex w/ pulse (Unstable)
C303
- If rhythm is Torsades de Pointes- Mag Sulfate 1 gram
- If patient is to be cardioverted and does not have an altered LOC, consider sedation- Versed 2-4 mg IV/IM until patient’s speech slurs or a total of 8 mg
- Synchronized cardioversion at 100 joules (or biphasic equiv.)
- If no change, repeat synchronized cardioversion at 200/300/360 (or biphasic equiv.)
- Obtain 12-lead EKG after successful conversion
Tachycardias – Wide Complex (Stable)
C304
- Obtain 12-lead EKG of initial rhythm
- If rhythm is Torsades de Pointes, Mag Sulfate 1 gram
- Consider Adenosine 6/12 if rhythm is regular
- Amiodarone 150 mg IV/IO over 10 minutes
- If wide complex tach persists, may repeat Amiodarone 150 mg IV/IO over 10 minutes
- Obtain a 12-lead EKG after any rhythm change
Tachycardias – Narrow Complex w/ pulse (Unstable)
C306
- Obtain 12-Lead EKG of initial rhythm
- If patient is to be cardioverted and does not have an altered LOC, consider sedation- Versed 2-4 mg IV/IO/IM until patient’s speech slurs or a total of 8 mg
- Atrial fibrillation: synchronized cardioversion at initial energy of 120-200 joules biphasic
- Atrial flutter and all other SVTs: synchronized cardioversion at initial energy of 50-100 joules biphasic
- If initial energy level fails, increase energy stepwise 100/ 200/ 300/ 360
- If no change from above, contact medical control
- If patient converts, obtain 12-lead EKG
Tachycardias – Narrow Complex (Stable)
C305
- Valsalva maneuver and note changes (or absence of)
- Obtain a 12-lead EKG after Valsalva maneuver
- Adenosine 6 mg with immediate 10 ml NaCl 0.9% flush
- Adenosine 12 mg with immediate 10 ml NaCl 0.9% flush
- Adenosine 12 mg with immediate 10 ml NaCl 0.9% flush
- Obtain a 12-lead EKG after any rhythm change
- Notify receiving hospital if patient fails to convert