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:
- SYNCHRONIZED CARDIOVERSION @ 100 Joules.
- 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 @ 300 Joules.
- If NO response, SYNCHRONIZED CARDIOVERSION @ 360 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.
If the patient presents with one or more of the above UNSTABLE criteria, DEFIBRILLATION should be administered to avoid delays associated with synchronization.