Ventricular Tachycardia with a Palpable Pulse

Section 4 - CARDIAC

4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE

• INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM.

STABLE AND SYMPTOMATIC:

• 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 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:

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.