View source for Wide Complex Tachycardia Uncertain Origin

==Section 4 - CARDIAC==
===4.10 WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >150 beats/minute)===

* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.

====STABLE and SVT highly likely:====
* Administer [[Antiarrhythmics|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, [[Antiarrhythmics|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:====
* [[Antiarrhythmics|LIDOCAINE]] 1 to 1.5 mg/kg IV over 3-5 minutes 
**If no response, [[Antiarrhythmics|LIDOCAINE]] 0.5-0.75 mg/kg IV over 3-5 minutes (may repeat to a maximum of 3 mg/kg administered) 
**In patients over age 70 or in those with known hepatic disease limit the use of [[Antiarrhythmics|LIDOCAINE]] to a maximum of 1.5 mg/kg)

====UNSTABLE WIDE COMPLEX TACHYCARDIA:====

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! Definition of Unstable: Persistent Wide Complex Tachyarrhythmia causing:
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*Hypotension or signs of decreased tissue perfusion 
*Significant dyspnea or significant compromise of the airway 
*Acute mental status change 
*Signs/symptoms of shock 
*Acute heart failure 
*Ischemic chest discomfort
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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)
* If IV established prior to patient becoming UNSTABLE, may administer [[Sedative Hypnotics|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.

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! 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

'''''Physician's Orders: If no response, contact Medical Control for consult.'''''

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! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex.
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