(17) TACHYCARDIA STABLE SVT Narrow Complex and Regular – 1. To convert: Adenosine 6 mg IV push with flush. May give Signs: 2nd dose: 12 mg IV CHECK FOR PULSE If no pulse, Go to PEA algorithm 2. If NOT converted, may Rate Control Choose beta blocker If Unstable, Go to SVT UNSTABLE and Prepare for or calcium channel blocker: – Synchronized Cardioversion a. Start 0.5 mg/kg IV over 1 min. May Esmolol: UNSTABLE = SBP<80, BP low for patient, rapid BP repeat after 1 min and may start infusion 50 decrease, or acute ischemia Sinus Tachycardia is NOT SVT. May be compensatory. b. Metoprolol: Start 1-2.5 mg IV. May repeat or Search for and treat underlying cause(s) double after 2.5 min More likely SVT if any of: c. Diltiazem: 5-10 mg IV over 2 min. May repeat Rate > 150 Sudden onset after 5 min Irregular rhythm 3. Amiodarone: 150 mg IV SLOWLY over 10 min. May repeat once. Start infusion 1mg/min for first 6 hours CALL FOR HELP CONSIDER HAVING CODE CART AVAILABLE Narrow Complex and Irregular INFORM TEAM Choose beta blocker or calcium channel blocker: Esmolol: Start 0.5 mg/kg IV over 1 min. May Treatment: repeat after 1 min and may start infusion 50 1. Increase to 100% O2, high flow Metoprolol: Start 1-2.5 mg IV. May repeat or 2. Confirm adequate ventilation, oxygenation double after 2.5 min 3. Consider 12-lead EKG or Print Rhythm Strip, then treat Diltiazem: 5-10 mg IV over 2 min. May repeat per rhythm 5 min 4. If UNSTABLE at any point: Go to Unstable SVT algorithm Amiodarone: 150 mg IV SLOWLY over 10 min. May 5. If still STABLE Supraventricular Tachycardia: repeat once. Start infusion 1 mg/min for first 6 hours a. Consider cardiology consult b. Consider ABG with electrolytes Wide Complex and Regular Amiodarone: 150 mg IV SLOWLY over 10 min. May repeat once. infusion 1 mg/min for first 6 hours May also consider Procainamide or Sotalol
(17) TACHYCARDIA – STABLE SVT Signs: CHECK FOR PULSE If no pulse, Go to PEA algorithm If Unstable, Go to SVT – UNSTABLE and Prepare for Synchronized Cardioversion UNSTABLE = SBP<80, BP low for patient, rapid BP decrease, or acute ischemia Sinus Tachycardia is NOT SVT. May be compensatory. Search for and treat underlying cause(s) More likely SVT if any of: Rate > 150 Sudden onset Irregular rhythm CALL FOR HELP CONSIDER HAVING CODE CART AVAILABLE INFORM TEAM Treatment: 1. Increase to 100% O2, high flow 2. Confirm adequate ventilation, oxygenation 3. Consider 12-lead EKG or Print Rhythm Strip, then treat per rhythm 4. If UNSTABLE at any point: Go to Unstable SVT algorithm 5. If still STABLE Supraventricular Tachycardia: a. Consider cardiology consult b. Consider ABG with electrolytes Narrow Complex and Regular 1. To convert: Adenosine 6 mg IV push with flush. May give 2nd dose: 12 mg IV 2. If NOT converted, may Rate Control Choose beta blocker or calcium channel blocker: a. Esmolol: Start 0.5 mg/kg IV over 1 min. May repeat after 1 min and may start infusion 50 b. Metoprolol: Start 1-2.5 mg IV. May repeat or double after 2.5 min c. Diltiazem: 5-10 mg IV over 2 min. May repeat after 5 min 3. Amiodarone: 150 mg IV SLOWLY over 10 min. May repeat once. Start infusion 1mg/min for first 6 hours Narrow Complex and Irregular Choose beta blocker or calcium channel blocker: Esmolol: Start 0.5 mg/kg IV over 1 min. May repeat after 1 min and may start infusion 50 Metoprolol: Start 1-2.5 mg IV. May repeat or double after 2.5 min Diltiazem: 5-10 mg IV over 2 min. May repeat 5 min Amiodarone: 150 mg IV SLOWLY over 10 min. May repeat once. Start infusion 1 mg/min for first 6 hours Wide Complex and Regular Amiodarone: 150 mg IV SLOWLY over 10 min. May repeat once. infusion 1 mg/min for first 6 hours May also consider Procainamide or Sotalol
Emergency%20Protocols.docx