Download Adult Tachycardia

Adult Tachycardia
Narrow Complex (≤ 0.11 sec)
History
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Medications
(Aminophylline, Diet pills, Thyroid
supplements, Decongestants,
Digoxin)
Diet (caffeine, chocolate)
Drugs (nicotine, cocaine)
Past medical history
History of palpitations / heart racing
Syncope / near syncope
NO
Signs and Symptoms
Differential
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Heart Rate > 150
Systolic BP < 90
Dizziness, CP, SOB, AMS,
Diaphoresis
CHF
Potential presenting rhythm
Atrial/Sinus tachycardia
Atrial fibrillation / flutter
Multifocal atrial tachycardia
Ventricular Tachycardia
·
·
Unstable / Serious Signs and Symptoms
HR Typically > 150
B
I
IV Procedure
P
Narrow / Regular: 50 -100 J
Narrow / Irregular: 120 - 200 J
Adenosine 6 mg IV / IO
Rapid push
May repeat 12 mg IV / IO X 2
doses if needed
YES
If no response
Diltiazem 5 mg / hr IV / IO
If rate not controlled repeat
bolus in 15 minutes
Diltiazem 25 mg IV / IO
If age ≥ 60 give 15 mg then
repeat 10 mg in 5 minutes
if SBP ≥ 100
Increase infusion to 10 mg / hr
Rhythm Converts
Single lead ECG able to
diagnose and treat arrhythmia
NO
12 Lead ECG not necessary to
diagnose and treat, but preferred
when patient is stable.
Diltiazem 20 mg IV / IO
If age ≥ 60 give 10 mg then
repeat 10 mg in 5 minutes
if SBP ≥ 100
YES
NO
Diltiazem 20 mg IV / IO
If age ≥ 60 give 10 mg then
repeat 10 mg in 5 minutes
if SBP ≥ 100
Exit to
Appropriate
Protocol
Consider
Adenosine 6 mg IV / IO
Rapid push
May repeat 12 mg IV / IO X 2
doses if needed
May aid rhythm identification
P
If no response
Diltiazem 5 mg / hr IV / IO
If rate not controlled repeat
bolus in 15 minutes
Diltiazem 25 mg IV / IO
If age ≥ 60 give 15 mg then
repeat 10 mg in 5 minutes
if SBP ≥ 100
Increase infusion to 10 mg / hr
Rhythm Converts /
Rate Controlled
NO
YES
B
12 Lead ECG Procedure
Notify Destination or
Contact Medical Control
Protocol 16
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
Adult Cardiac Section Protocols
P
YES
NO
Rhythm Converts
Consider Sedation pre-shock
Midazolam 2 - 2.5 mg IV / IO
May repeat if needed
Maximum 5 mg
Irregular Rhythm
(Atrial Fibrillation / Flutter)
Attempt Vagal Maneuvers
Revised
10/30/2013
May repeat if needed and
increase dose with subsequent
shocks
P
Cardiac Monitor
Rhythm Converts
P
Cardioversion Procedure
IO Procedure
Regular Rhythm
(SVT)
P
YES
12 Lead ECG Procedure
P
P
Heart disease (WPW, Valvular)
Sick sinus syndrome
Myocardial infarction
Electrolyte imbalance
Exertion, Pain, Emotional stress
Fever
Hypoxia
Hypovolemia or Anemia
Drug effect / Overdose (see HX)
Hyperthyroidism
Pulmonary embolus
Adult Tachycardia
Narrow Complex (≤ 0.11 sec)
Adult Cardiac Section Protocols
Pearls
· Recommended Exam: Mental Status, Skin, Neck, Lung, Heart, Abdomen, Back, Extremities, Neuro
· Most important goal is to differentiate the type of tachycardia and if STABLE or UNSTABLE.
· If at any point patient becomes unstable move to unstable arm in algorithm.
· Symptomatic tachycardia usually occurs at rates of 120 -150 and typically ≥ 150 beats per minute. Patients
symptomatic with heart rates < 150 likely have impaired cardiac function such as CHF.
· Serious Signs / Symptoms:
Hypotension. Acutely altered mental status. Signs of shock / poor perfusion. Chest pain with evidence of
ischemia (STEMI, T wave inversions or depressions.) Acute CHF.
· Search for underlying cause of tachycardia such as fever, sepsis, dyspnea, etc.
· If patient has history or 12 Lead ECG reveals Wolfe Parkinson White (WPW), DO NOT administer a Calcium
Channel Blocker (e.g. Diltiazem) or Beta Blockers. Use caution with Adenosine and give only with defibrillator
available.
· Typical sinus tachycardia is in the range of 100 to (200 - patient’s age) beats per minute.
· Regular Narrow-Complex Tachycardias:
Vagal maneuvers and adenosine are preferred. Vagal maneuvers may convert up to 25 % of SVT.
Adenosine should be pushed rapidly via proximal IV site followed by 20 mL Normal Saline rapid flush.
Agencies using both calcium channel blockers and beta blockers need choose one primarily. Giving the agents
sequentially requires Contact of Medical Control. This may lead to profound bradycardia / hypotension.
· Irregular Tachycardias:
First line agents for rate control are calcium channel blockers or beta blockers.
Agencies using both calcium channel blockers and beta blockers need choose one primarily. Giving the agents
sequentially requires Contact of Medical Control. This may lead to profound bradycardia / hypotension.
Adenosine may not be effective in identifiable atrial fibrillation / flutter, yet is not harmful and may help identify rhythm.
· Synchronized Cardioversion:
Recommended to treat UNSTABLE Atrial Fibrillation, Atrial Flutter and Monomorphic-Regular Tachycardia (VT.)
· Monitor for hypotension after administration of Calcium Channel Blockers or Beta Blockers.
· Monitor for respiratory depression and hypotension associated with Midazolam.
· Continuous pulse oximetry is required for all SVT patients.
· Document all rhythm changes with monitor strips and obtain monitor strips with each therapeutic intervention.
Revised
10/30/2013
Protocol 16
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS