Supraventricular Tachycardia

Section 4 - CARDIAC 4.07

CONSIDER MEDICAL ETIOLOGY OF SVT AND REFER TO APPROPRIATE PRACTICE PARAMETER:

• Heart failure, PULMONARY EDEMA (4.11).
• Hypovolemia, SHOCK (5.13).
• Side-effects of other drugs, etc.

INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask.

STABLE NARROW COMPLEX TACHYCARDIA:

• Initiate large bore IV, preferably at antecubital fossae
• Administer ADENOSINE 12 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 24 mg)

UNSTABLE:

Definition of Unstable: Persistent Narrow Complex Tachyarrhythmia causing:
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

• If IV established prior to patient becoming UNSTABLE, may administer ADENOSINE 12 mg RAPID IVP. If unrelieved, consider sedation with VERSED (2.04) if patient is conscious and proceed with below therapies.
  • 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)

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