History:

 

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

 

Significant findings:

 

• Ventricular tachycardia on EKG (runs/sustained)
• Chest pain
• Diaphoresis
• Dizziness
• SOB
• Heart rate usually 150-180 for sustained V-tach
• QRS >0.12

 

Differential:

 

• Artifact/device failure
• Cardiac
• Endocrine/metabolic
• Drugs
• Pulmonary

 

Palpable pulse or wide, regular rhythm with QRS >0.12 sec ?

 

• Yes

 

• • Oxygen

• • 12- Lead EKG

• • Initiate IV

 

•  No

 

• • See appropriate protocol

 

Stable ?

 

• Yes

 

• • Consider Adenosine (Adenocard) 12 mg rapid IV for sustained regular wide-complex tachycardia

 

• • Amiodarone (Cordarone) 150 mg IV over 10 min; may repeat once

 

Unstable ?

 

• Yes

 

• • Consider conscious sedation

 

• Synchronized Cardioversion

 

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

• • Amiodarone (Cordarone) 150 mg IV over 10 min
  • Cardiovert (synchronized) 360 joules

• • Amiodarone (Cordarone) 150 mg IV over 10 min
  • Cardiovert (synchronized) 360 joules

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Stable ventricular tachycardia is defined as a hemodynamically stable patient in ventricular tachycardia without signs or symptoms of poor perfusion.
• Wide and fast = V-tach.
• Diltiazem (Cardizem) can cause V-fib in the V-tach patient.

• Administer Amiodarone infusion at 1 mg/min after successful conversion of V-tach.

 

150 mg infusion over 10 minutes:

 

• 50 mL bag of Normal Saline

• Add 150 mg of Amiodarone
• administer through a 10 gtt set at 50 drops per minute.

 

1 mg/min infusion:

 

• 50 mL bag of Normal Saline

• Add 150 mg Amiodarone
• administer through a 60 gtt set at 20 drops per minute.

 

• If torsades de pointes administer Magnesium Sulfate 1-2 grams/2-4 mL slow IV push over 2 minutes.

• WPW should be treated with cardioversion or Amiodarone (Cordarone)
• If the patient is receiving shocks from an automated internal cardiac defibrillator (AICD) and the device is shocking appropriately, utilize medications and cardioversion as if the device was not present after the second shock delivered by the AICD. It is important to place the pads a minimum of 3 inches away from the AiCD.

• If the device is malfunctioning and shocking is not appropriate, utilize conscious sedation
• For conscious sedation, see Sedation/Anxiety protocol. Dose should be titrated to provide comfort without causing respiratory failure. Be sure to monitor patient's breathing/ventilations, blood pressure and O2 saturation.