Indications: Symptomatic Tachycardia

Valsalva Maneuver: If the patient is ≥ 18 years of age with an unaltered LOA, a HR ≥ 150BPM, normotensive with a narrow complex and regular rhythm (excluding sinus tachycardia, a-fib and a-flutter) you may perform a maximum of 2 attempts lasting 10 to 20 seconds in duration for each attempt.

Adenosine: If the patient is ≥ 18 years of age with an unaltered LOA, a HR ≥ 150BPM, is normotensive with a narrow complex and regular rhythm (excluding sinus tachycardia, a-fib and a-flutter) and they do not have a sensitivity or allergy to adenosine, they do not have bronchoconstriction and are not taking dipyridamole or carbamazepine you may administer a maximum of 2 doses of adenosine.

Pediatric Tachycardia

Administer an initial dose of adenosine 6mg IV, if conditions persist after 2 minutes administer a second dose of adenosine 12mg IV.

Mandatory Patch Point: Patch to BHP for authorization to proceed with amiodarone or lidocaine or if monomorphic wide complex regular rhythm for adenosine.

Amiodarone: If the patient is ≥ 18 years of age with an unaltered LOA with a HR ≥ 120 BPM and is normotensive with a wide complex and regular rhythm and does not have allergy or sensitivity to amiodarone you may administer a maximum of 2 doses of amiodarone. Administer an initial dose of amiodarone 150mg IV.

If condition persists after 10 minutes administer a second dose of amiodarone 150mg IV.

Lidocaine: If the patient is ≥18 years of age with an unaltered LOA with a HR ≥ 120 BPM and is normotensive with a wide complex and regular rhythm and does not have allergy or sensitivity to lidocaine you may administer a maximum of 3 doses of lidocaine.

Administer an initial dose of Lidocaine 1.5mg/kg IV (maximum single dose not to exceed 150mg).

If condition persists after 10 minutes administer a 2nd dose of Lidocaine 0.75mg/kg (maximum single dose not to exceed 150mg).

If after another 10 minutes condition persists administer a 3rd dose of Lidocaine 0.75mg/kg (maximum single dose not to exceed 150mg).

Synchronized Cardioversion: If the patient is ≥ 18 years of age with a wide rhythm ≥ 120 BPM or a narrow rhythm ≥ 150 BPM, and is hypotensive with an altered mental status, ongoing chest pain or other signs of shock patch to BHP for authorization to perform synchronized cardioversion.

Administer up to 3 synchronized shocks in accordance with BHP direction and energy setting. In the event of a patch failure the energy setting to be used are 100 Joules, 200 Joules and the maximum manufacturer energy setting.

Procedure

• Administer 100% O2, manage airway, and ventilate as indicated. Obtain vital signs and confirm that the patient is clinically or hemodynamically unstable.
• Initiate continuous cardiac monitoring and pulse oximetry (if available).
• Obtain 10 second cardiac strip to confirm rhythm.
• Initiate IV access (preferably antecubital fossa and large bore) and initiate fluid therapy as indicated.
• Contact the BHP for consideration of orders to administer synchronized cardioversion and for sedation, as necessary.

o              Administer sedation/analgesia as per BHP order.

o              Perform synchronized cardioversion as per BHP order. Initial shock would normally be 100 J. A specific order must be obtained from the BHP.

o              If unable to perform synchronized cardioversion adjust again. If still unable to synchronize, deliver an unsynchronized shock at same settings as BHP order.

o              Evaluate the patient after each shock is delivered. If the patient worsens, the rhythm changes, or cardioversion is unsuccessful, re-establish BHP contact enroute.

o              If every attempt to contact the BHP has failed and the patient is worsening the paramedic may perform cardioversion as above. The paramedic should continue to attempt to contact the BHP.

• Consider obtaining a 12 lead ECG (as per Auxiliary 12-Lead Acquisition Protocol) prior to cardioversion, if time permits.