Ventricular Tachycardia with a Palpable Pulse - Revision history

Treloars at 23:49, 23 April 2020

2020-04-23T23:49:06Z

Treloars at 15:45, 1 February 2018

2018-02-01T15:45:28Z

← Older revision		Revision as of 15:45, 1 February 2018
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	! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.		! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
	\|}		\|}

			[[Category:Cardiac\|0409]]

Treloars: /* STABLE AND SYMPTOMATIC: */

2013-03-19T14:35:32Z

STABLE AND SYMPTOMATIC:

← Older revision		Revision as of 14:35, 19 March 2013
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	* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.		* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.
	====STABLE AND SYMPTOMATIC:====		====STABLE AND SYMPTOMATIC:====
			* Administer [[Antiarrhythmics\|AMIODARONE]] 150 mg in 50 ml over 10 minutes.
			:'''OR'''
	* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;		* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;
	**If NO response, repeat [[Antiarrhythmics\|LIDOCAINE]] 0.5 mg/kg IVP until maximum of 3 mg/kg administered.		**If NO response, repeat [[Antiarrhythmics\|LIDOCAINE]] 0.5 mg/kg IVP until maximum of 3 mg/kg administered.

Treloars: /* STABLE AND SYMPTOMATIC: */

2013-03-18T15:08:18Z

STABLE AND SYMPTOMATIC:

← Older revision		Revision as of 15:08, 18 March 2013
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	====STABLE AND SYMPTOMATIC:====		====STABLE AND SYMPTOMATIC:====
	* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;		* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;
	* If NO response, repeat [[Antiarrhythmics\|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 [[Antiarrhythmics\|LIDOCAINE]] ~~boluses~~ at ~~0.25 mg/kg~~ until maximum of 1.5 mg / kg administered.		**If NO response, repeat [[Antiarrhythmics\|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 [[Antiarrhythmics\|LIDOCAINE]] at a full loading dose or until maximum of 1.5 mg/kg administered.

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

Treloars at 17:53, 3 May 2012

2012-05-03T17:53:13Z

← Older revision		Revision as of 17:53, 3 May 2012
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	===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===		===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===

			* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.
	* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01) - ~~[[Medical Gases\|~~OXYGEN]] @ 100% via NRB mask or assist with BVM.		====STABLE AND SYMPTOMATIC:====

	====STABLE AND SYMPTOMATIC: ====
	* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;		* [[Antiarrhythmics\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics\|LIDOCAINE]] DRIP @ 2 mg / minute;
	* If NO response, repeat [[Antiarrhythmics\|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 [[Antiarrhythmics\|LIDOCAINE]] boluses at 0.25 mg/kg until maximum of 1.5 mg / kg administered.		* If NO response, repeat [[Antiarrhythmics\|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 [[Antiarrhythmics\|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.'''''
	'''''Physician's Orders: If NO response, contact Medical Control for consult. '''''

	====UNSTABLE:====		====UNSTABLE:====
	* ~~[[Cardioversion~~\|SYNCHRONIZED CARDIOVERSION~~]] @~~ 100 Joules.		{\| class="wikitable"
	* 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.		\|-
			! 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 [[Antiarrhythmics\|LIDOCAINE]].		* If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Antiarrhythmics\|LIDOCAINE]].
	* If NO response, ~~[[Cardioversion\|~~SYNCHRONIZED CARDIOVERSION]] @ 200 ~~Joules.~~		* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
	* If NO response. [[Cardioversion\|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.		* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.
	* If NO response, [[Cardioversion\|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
	* If NO response, ~~[[Cardioversion\|~~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~~\|DEFIBRILLATION]] should be ~~administered~~ to avoid delays associated with synchronization.		{\| class="wikitable"
			\|-
			! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
			\|}

Treloars: Created page with "==Section 4 - CARDIAC== ===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE=== * INITIAL MEDICAL CARE (2.01) - [[Medical Gases|OXYG..."

2012-02-02T21:04:39Z

Created page with "==Section 4 - CARDIAC== ===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE=== * INITIAL MEDICAL CARE (2.01) - [[Medical Gases|OXYG..."

New page

==Section 4 - CARDIAC==
===4.09 VENTRICULAR TACHYCARDIA with a PALPABLE PULSE===

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

====STABLE AND SYMPTOMATIC: ====
* [[Antiarrhythmics|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Antiarrhythmics|LIDOCAINE]] DRIP @ 2 mg / minute;
* If NO response, repeat [[Antiarrhythmics|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 [[Antiarrhythmics|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:====
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
* 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 Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Antiarrhythmics|LIDOCAINE]].
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 200 Joules.
* If NO response. [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 360 Joules.
* If NO response, [[Cardioversion|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|DEFIBRILLATION]] should be administered to avoid delays associated with synchronization.

← Older revision		Revision as of 23:49, 23 April 2020
Line 4:		Line 4:
	* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.		* [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask or assist with BVM.
	====STABLE AND SYMPTOMATIC:====		====STABLE AND SYMPTOMATIC:====
	* Administer [[~~Antiarrhythmics~~\|AMIODARONE]] 150 mg in 50 ml over 10 minutes.		* Administer [[Amiodarone\|AMIODARONE]] 150 mg in 50 ml over 10 minutes.
	:'''OR'''		:'''OR'''
	* [[~~Antiarrhythmics~~\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[~~Antiarrhythmics~~\|LIDOCAINE]] DRIP @ 2 mg / minute;		* [[Lidocaine\|LIDOCAINE]] 1.5 mg / kg IVP. If NO response, repeat at 0.5 mg / kg IVP in 5 minutes. If tachycardia converts start [[Lidocaine\|LIDOCAINE]] DRIP @ 2 mg / minute;
	**If NO response, repeat [[~~Antiarrhythmics~~\|LIDOCAINE]] 0.5 mg/kg IVP until maximum of 3 mg/kg administered.		**If NO response, repeat [[Lidocaine\|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 [[~~Antiarrhythmics~~\|LIDOCAINE]] at a full loading dose or until maximum of 1.5 mg/kg administered.		* In patients over age 70 or in those with known hepatic disease, administer [[Lidocaine\|LIDOCAINE]] at a full loading dose or until maximum of 1.5 mg/kg administered.

	'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''		'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''
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	*** If wide and irregular complexes – use defibrillation dose (not synchronized)		*** 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 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 [[~~Antiarrhythmics~~\|LIDOCAINE]].		* If Ventricular Tachycardia converts refer to STABLE PRACTICE PARAMETER for administration of [[Lidocaine\|LIDOCAINE]].
	* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.		* If NO response, SYNCHRONIZED CARDIOVERSION @ 200 Joules.
	* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.		* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.