Wide Complex Tachycardia Uncertain Origin: Difference between revisions
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! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex. | ! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex. | ||
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[[Category:Cardiac|0410]] |
Revision as of 15:45, 1 February 2018
Section 4 - CARDIAC
4.10 WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >150 beats/minute)
- INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM.
STABLE and SVT highly likely:
- Administer ADENOSINE 6 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10-20 ml saline flush
- If NO response in 2 minutes, ADENOSINE 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 18 mg)
STABLE and unknown wide complex or ventricular tachycardia likely:
- LIDOCAINE 1 to 1.5 mg/kg IV over 3-5 minutes
UNSTABLE WIDE COMPLEX TACHYCARDIA:
Definition of Unstable: Persistent Wide Complex Tachyarrhythmia causing: |
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- SYNCHRONIZED CARDIOVERSION
- Initial recommended doses:
- If narrow and regular complexes 50-100 Joules biphasic
- If narrow and irregular complexes 120-200 Joules biphasic
- If wide and regular complexes 100 Joules biphasic
- If wide and irregular complexes – use defibrillation dose (not synchronized)
- Initial recommended doses:
- If IV established prior to patient becoming UNSTABLE, may administer VERSED 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
- If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
- If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.
DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization. |
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Following electrical cardioversion if no antiarrythmic agent was given:
- Administer LIDOCAINE 1.0 mg/kg IV bolus.
- Use ½ above dose if hypotensive.
- Follow with continuous infusion at 2-4 mg/min
- Contraindicated if ventricular escape rhythm
- If LIDOCAINE was given previously
- Follow with continuous infusion at 2-4 mg/min
- Contraindicated if ventricular escape rhythm.
- If HYPERKALEMIA suspected in any wide complex Tachycardia:
- Suspect in patients with any of the following:
- Diagnosis of Renal Failure or any form of Kidney insufficiency
- Widening QRS
- Increased K+ in diet (excessive consumption of cherries, bananas, melons or citrus), Acidosis, or Shock.
- Note last dialysis TX.
- CALCIUM CHLORIDE 1 gm IV (Avoid if patient is on digoxin/lanoxin)
- SODIUM BICARBONATE 1 mEq/kg IV
- Suspect in patients with any of the following:
Physician's Orders: If no response, contact Medical Control for consult.
Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex. |
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