SVT (QRS < 0.12)

 

History:

 

  • Medications
  • Aminophylline
  • Diet pills
  • Thyroid supplements
  • Decongestants
  • Digoxin
  • Diet (caffeine/chocolate)
  • Drugs (nicotine/cocaine)
  • Past medical history
  • History of palpitation/heart racing
  • Syncope/near syncope

 

Significant findings:

 

  • Heart rate >150
  • Chest pain
  • Systolic BP < 90
  • CHF
  • Dizziness
  • SOB
  • Diaphoresis
  • AMS
  • If QRS >0.12 or history of WPW, go to Sustained V-Tach Protocol
  • Potential presenting rhythm:
  • Atrial/sinus tachycardia
  • Atrial fibrillation/flutter
  • Multifocal atrial tachycardia

 

Differential:

 

  • Hypoxia
  • Fever
  • Sepsis
  • Dehydration
  • Sick sinus syndrome
  • Myocardial infarction
  • Electrolyte imbalance
  • Exertion/pain/emotional stress
  • Hypovolemia/anemia
  • Drugs/medications (see History)
  • Hyperthyroidism
  • Pulmonary embolus
  • Heart disease (WPW, valvular)

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • 12-Lead EKG

 

 

 

  • Initiate IV of Normal Saline (INT is not acceptable)

 

 

 

  • Attempt valsalva maneuver

 

Stable Tachycardia (QRS < 0.12) ?

 

  • No

 

See V-Tach Protocol

 

  • Yes

 

Regular ?

 

  • Yes

 

 

 

 

Improving ?

 

  • Yes

 

    • Notify receiving facility or contact Medical Control

 

  • No

 

    • Go to Irregular below

 

Stable Irregular Tachycardia ?

 

  • Yes

 

 

 

 

 

    • Notify receiving facility or contact Medical Control

 

Unstable Tachycardia (QRS <0.12) ?

 

  • Yes

 

 

 

 

  • Synchronized Cardioversion

 

    • Cardiovert (synchronized) 100 joules
    • Cardiovert (synchronized) 200 joules
    • Cardiovert (synchronized) 300 joules
    • Cardiovert (synchronized) 360 joules

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Symptomatic tachycardia usually occurs at rates of 120-150 and are typically greater than or equal to 150 beats per minute. Symptomatic patients with heart rates less than 150 likely have impaired cardiac function such as CHF.
  • Typical sinus tachycardia is in the range of 100 to (220 minus patient's age) beats per minute.
  • Serious signs/symptoms:
    • hypotension,
    • acutely altered mental status,
    • signs of shock/poor perfusion,
    • chest pain with evidence of STEMI or
    • T- wave inversions or depressions,
    • acute CHF.
  • If the patient has a history of WPW or 12-Lead EKG reveals WPW, DO NOT administer a calcium channel blocker (e.g., Diltiazem (Cardizem)) or a beta blocker.
  • Avoid carotid sinus massage in patients over 50 years old or with a history of prior neurological event.
  • For A-fib/A-flutter, consider administering Diltiazem (Cardizem) prior to administration of Adenosine (Adenocard).

 

 

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NRP

National Registry Paramedic