Ventricular Tachycardia with a Palpable Pulse: Difference between revisions

From Protocopedia
Jump to navigation Jump to search
VisualWikitext
(Created page with "==Section 4 - CARDIAC== ===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE=== * INITIAL MEDICAL CARE (2.01) - [[Medical Gases|OXYG...")
 
No edit summary
 
(4 intermediate revisions by the same user not shown)
Line 2: Line 2:
===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===
===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===


* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.
====STABLE AND SYMPTOMATIC:====
* Administer [[Amiodarone|AMIODARONE]] 150 mg in 50 ml over 10 minutes.
:'''OR'''
* [[Lidocaine|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Lidocaine|LIDOCAINE]] DRIP @ 2 mg / minute;
**If NO response, repeat [[Lidocaine|LIDOCAINE]] 0.5 mg/kg IVP until maximum of 3 mg/kg administered.
* In patients over age 70 or in those with known hepatic disease, administer [[Lidocaine|LIDOCAINE]] at a full loading dose or until maximum of 1.5 mg/kg administered.


* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.
'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''
 
====STABLE AND SYMPTOMATIC: ====
* [[Antiarrhythmics|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics|LIDOCAINE]] DRIP @ 2 mg / minute;
* If NO response, repeat [[Antiarrhythmics|LIDOCAINE]] 0.5 mg / kg IVP until maximum of 3 mg/kg administered. In patients over age 70 or in those with known hepatic disease, administer [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg/kg until maximum of 1.5 mg / kg administered.
 
 
'''''Physician's Orders: If NO response, contact Medical Control for consult. '''''


====UNSTABLE:====
====UNSTABLE:====
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
{| class="wikitable"
* 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 Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Antiarrhythmics|LIDOCAINE]].
! Definition of Unstable: Persistent Wide Complex Tachyarrhythmia causing:
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 200 Joules.
|-
* If NO response. [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.
|
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
*Hypotension or signs of decreased tissue perfusion
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
*Significant dyspnea or significant compromise of the airway
 
*Acute mental status change
*Signs/symptoms of shock
*Acute heart failure
*Ischemic chest discomfort
|}
* 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 VERSED 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
* If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Lidocaine|LIDOCAINE]].
* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.


This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''
{| class="wikitable"
|-
! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
|}


If the patient presents with one or more of the above UNSTABLE criteria, [[Defibrillation|DEFIBRILLATION]] should be administered to avoid delays associated with synchronization.
[[Category:Cardiac|0409]]

Latest revision as of 23:49, 23 April 2020

Section 4 - CARDIAC

4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE

STABLE AND SYMPTOMATIC:

  • Administer AMIODARONE 150 mg in 50 ml over 10 minutes.
OR
  • LIDOCAINE 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start LIDOCAINE DRIP @ 2 mg / minute;
    • If NO response, repeat LIDOCAINE 0.5 mg/kg IVP until maximum of 3 mg/kg administered.
  • In patients over age 70 or in those with known hepatic disease, administer LIDOCAINE at a full loading dose or until maximum of 1.5 mg/kg administered.

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

UNSTABLE:

Definition of Unstable: Persistent Wide 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
  • 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 VERSED 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
  • If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of LIDOCAINE.
  • 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.
Retrieved from "http://roaddoc.com/scems/index.php?title=Ventricular_Tachycardia_with_a_Palpable_Pulse&oldid=1399"