Wide Complex Tachycardia Uncertain Origin - Revision history

Mfrdmanager at 13:41, 13 November 2020

2020-11-13T13:41:44Z

Mfrdmanager: /* STABLE and SVT highly likely: */

2019-09-16T18:41:53Z

‎STABLE and SVT highly likely:

Mfrdmanager: Protected "Wide Complex Tachycardia Uncertain Origin" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

2018-02-10T14:07:51Z

Protected "Wide Complex Tachycardia Uncertain Origin" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

Mfrdmanager: Created page with "==Section 4 - CARDIAC== ===4.10 WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >150 beats/minute)=== * Initial Medical Assessment and Care|INITIAL MEDICAL CARE (..."

2018-02-10T14:07:44Z

Created page with "==Section 4 - CARDIAC== ===4.10 WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >150 beats/minute)=== * Initial Medical Assessment and Care|INITIAL MEDICAL CARE (..."

New page

==Section 4 - CARDIAC==
===4.10 WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >150 beats/minute)===

* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.

====STABLE and SVT highly likely:====
* Administer [[Antiarrhythmics|ADENOSINE]] 6 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, [[Antiarrhythmics|ADENOSINE]] 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 18 mg)

====STABLE and unknown wide complex or ventricular tachycardia likely:====
* [[Antiarrhythmics|LIDOCAINE]] 1 to 1.5 mg/kg IV over 3-5 minutes
**If no response, [[Antiarrhythmics|LIDOCAINE]] 0.5-0.75 mg/kg IV over 3-5 minutes (may repeat to a maximum of 3 mg/kg administered)
**In patients over age 70 or in those with known hepatic disease limit the use of [[Antiarrhythmics|LIDOCAINE]] to a maximum of 1.5 mg/kg)

====UNSTABLE WIDE COMPLEX TACHYCARDIA:====

{| class="wikitable"
|-
! 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 [[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 NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.

{| class="wikitable"
|-
! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
|}

====Following electrical cardioversion if no antiarrythmic agent was given:====
* Administer LIDOCAINE 1.0 mg/kg IV bolus.
**Use ½ above dose if hypotensive.
**Follow with continuous infusion at 2-4 mg/min
**Contraindicated if ventricular escape rhythm
* If LIDOCAINE was given previously
**Follow with continuous infusion at 2-4 mg/min
**Contraindicated if ventricular escape rhythm.
* If HYPERKALEMIA suspected in any wide complex Tachycardia:
**Suspect in patients with any of the following:
***Diagnosis of Renal Failure or any form of Kidney insufficiency
***Widening QRS
***Increased K+ in diet (excessive consumption of cherries, bananas, melons or citrus), Acidosis, or Shock.
**Note last dialysis TX.
**CALCIUM CHLORIDE 1 gm IV (Avoid if patient is on digoxin/lanoxin)
**SODIUM BICARBONATE 1 mEq/kg IV

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

{| class="wikitable"
|-
! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex.
|}

[[Category:Cardiac|0410]]

@@ Line 5: / Line 5: @@
 ====STABLE and SVT highly likely:====
-* Administer [[Antiarrhythmics|ADENOSINE]] 12 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10-20 ml saline flush
+* Administer [[Adenosine|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, [[Antiarrhythmics|ADENOSINE]] 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 18 mg)
+* If NO response in 2 minutes, [[Adenosine|ADENOSINE]] 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 24 mg)
 ====STABLE and unknown wide complex or ventricular tachycardia likely:====
-* [[Antiarrhythmics|LIDOCAINE]] 1 to 1.5 mg/kg IV over 3-5 minutes
+* [[Lidocaine|LIDOCAINE]] 1 to 1.5 mg/kg IV over 3-5 minutes
-**If no response, [[Antiarrhythmics|LIDOCAINE]] 0.5-0.75 mg/kg IV over 3-5 minutes (may repeat to a maximum of 3 mg/kg administered)
+**If no response, [[Lidocaine|LIDOCAINE]] 0.5-0.75 mg/kg IV over 3-5 minutes (may repeat to a maximum of 3 mg/kg administered)
-**In patients over age 70 or in those with known hepatic disease limit the use of [[Antiarrhythmics|LIDOCAINE]] to a maximum of 1.5 mg/kg)
+**In patients over age 70 or in those with known hepatic disease limit the use of [[Lidocaine|LIDOCAINE]] to a maximum of 1.5 mg/kg)
 ====UNSTABLE WIDE COMPLEX TACHYCARDIA:====
@@ Line 34: / Line 34: @@
 *** 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 [[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 IV established prior to patient becoming UNSTABLE, may administer [[Versed|VERSED]] 2-5 mg IVP, IO or IN AND REPEAT 2 mg every 30 seconds to one minute if patient is conscious.
 * If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
 * If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.

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