Wide Complex Tachycardia Uncertain Origin - Revision history

Treloars at 14:01, 24 April 2020

2020-04-24T14:01:41Z

← Older revision		Revision as of 14:01, 24 April 2020
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	*** If wide and regular complexes 100 Joules biphasic		*** If wide and regular complexes 100 Joules biphasic
	*** 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 [[~~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 @ 200 Joules.
	* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.		* If NO response, SYNCHRONIZED CARDIOVERSION @ 360 Joules.

Treloars at 23:50, 23 April 2020

2020-04-23T23:50:31Z

← Older revision		Revision as of 23:50, 23 April 2020
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	====STABLE and SVT highly likely:====		====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		* 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:====		====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:====		====UNSTABLE WIDE COMPLEX TACHYCARDIA:====

Treloars at 15:45, 1 February 2018

2018-02-01T15:45:50Z

← Older revision		Revision as of 15:45, 1 February 2018
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	! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex.		! Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex.
	\|}		\|}

			[[Category:Cardiac\|0410]]

Treloars: /* STABLE and unknown wide complex or ventricular tachycardia likely: */

2013-03-18T15:09:53Z

STABLE and unknown wide complex or ventricular tachycardia likely:

← Older revision		Revision as of 15:09, 18 March 2013
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	====STABLE and unknown wide complex or ventricular tachycardia likely:====		====STABLE and unknown wide complex or ventricular tachycardia likely:====
	* [[Antiarrhythmics\|LIDOCAINE]] 1 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~~, administer~~ [[Antiarrhythmics\|LIDOCAINE]] ~~boluses at 0.25 mg / kg (~~maximum of 1.5 mg / kg)		* [[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:====		====UNSTABLE WIDE COMPLEX TACHYCARDIA:====

Treloars at 18:24, 3 May 2012

2012-05-03T18:24:32Z

@@ Line 39: / Line 39: @@
 |-
 ! DEFIBRILLATION should be considered instead of synchronized cardioversion if the patient is deteriorating rapidly to avoid delays associated with synchronization.
 |}

Treloars at 18:21, 3 May 2012

2012-05-03T18:21:15Z

@@ Line 1: / Line 1: @@
-==Section 4 - CARDIAC 4.10==
+==Section 4 - CARDIAC==
-===WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >160 beats/minute)===
+===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
-==== STABLE and SVT highly likely: ====
+* 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 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, administer [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg / kg until maximum of 1.5 mg / kg.
+* [[Antiarrhythmics|LIDOCAINE]] 1 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, administer [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg / kg (maximum of 1.5 mg / kg)
 ====UNSTABLE WIDE COMPLEX TACHYCARDIA:====
-'''Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex. '''
+{| class="wikitable"
-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 CIRCUATION.'''''
+* SYNCHRONIZED CARDIOVERSION
-'''''If the patient presents with one or more of the above UNSTABLE criteria, DEFIBRILLATION should be administered to avoid delays associated with synchronization.'''''
+{| class="wikitable"

Treloars: Created page with "==Section 4 - CARDIAC 4.10== ===WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >160 beats/minute)=== * [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]..."

2012-02-02T21:21:13Z

Created page with "==Section 4 - CARDIAC 4.10== ===WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >160 beats/minute)=== * [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]..."

New page

==Section 4 - CARDIAC 4.10==
===WIDE COMPLEX TACHYCARDIA – UNCERTAIN ORIGIN (Heart rate >160 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: ====
* [[Antiarrhythmics|ADENOSINE (Adenocard)]] 6 mg rapid IVP over 1-3 seconds
* If no response in 2 minutes, [[Antiarrhythmics|ADENOSINE]] 12 mg rapid IVP over 1-3 seconds
* If no response in 2 minutes, repeat [[Antiarrhythmics|ADENOSINE]] 12 mg rapid IVP over 1-3 seconds

====STABLE and unknown wide complex or ventricular tachycardia likely:====
* [[Antiarrhythmics|LIDOCAINE]] 1 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, administer [[Antiarrhythmics|LIDOCAINE]] boluses at 0.25 mg / kg until maximum of 1.5 mg / kg.

====UNSTABLE WIDE COMPLEX TACHYCARDIA:====
* [[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 1 minute if patient is conscious.
* If tachycardia converts refer to STABLE section 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.
*Following electrical cardioversion if no antiarrythmic agent was given,
** Administer [[Antiarrhythmics|LIDOCAINE]] 1.0 mg/kg IV bolus. Use ½ dose if hypotensive. Follow with continuous infusion at 2-4 mg/min Contraindicated if ventricular escape rhythm
* If [[Antiarrhythmics|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.'''''

'''Discontinue boluses in patients who now manifest tachycardia with hypotension, altered mental status, or widening of the QRS complex. '''

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 CIRCUATION.'''''

'''''If the patient presents with one or more of the above UNSTABLE criteria, DEFIBRILLATION should be administered to avoid delays associated with synchronization.'''''