Supraventricular Tachycardia

Section 4 - CARDIAC 4.07

SUPRAVENTRICULAR TACHYCARDIA (Heart Rate > 160 beats / minute)

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 and SYMPTOMATIC:

• Initiate large bore IV, preferably at AC.
• ADENOSINE 6 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10 ml saline flush.
• If NO response in 2 minutes, ADENOSINE12 mg RAPID IVP followed immediately by a rapid 10 ml saline flush. May repeat once in 2 minutes. (Maximum total dose 30 mg)

UNSTABLE:

• If IV established prior to patient becoming UNSTABLE, may administer ADENOSINE6 mg RAPID IVP. If unrelieved, consider sedation with VERSED (2.04) if patient is conscious and proceed with below therapies.
• SYNCHRONIZED CARDIOVERSION @ 50 Joules. May repeat VERSED, if necessary.
• If NO response, SYNCHRONIZED CARDIOVERSION @ 100 Joules.
• If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
• If NO response, SYNCHRONIZED CARDIOVERSION @ 300 Joules.

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

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.

If the patient presents with one or more of the above UNSTABLE criteria, DEFIBRILLATION should be administered to avoid delays associated with synchronization.