Bonner County EMS System Patient Care Treatment Guidelines: Cardiac EmergenciesArrhythmia: Wide Complex Tachycardia -5024

WIDE COMPLEX TACHYCARDIA (VT)Prehospital Management of Wide Complex Tachycardia With a Palpable Pulse

HISTORY Past medical history/ medications,

diet, drugs. Syncope / near syncope CHF Palpitations Pacemaker Allergies: lidocaine / Novocain

SIGNS AND SYMPTOMS Ventricular tachycardia on EKG

(Runs or sustained) Conscious, rapid pulse Chest pain, shortness of breath Dizziness Rate usually 150-180 bpm for

sustained V-Tach QRS > .12 Sec

ASSESSMENT Artifact / Device failure Cardiac Endocrine / Metabolic Drugs Pulmonary

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact (2000). Administer Oxygen 10-15 L via non rebreather (9000). R If no palpable pulse, refer to VF/ Pulseless VT (3010) Guidelines. Assist ALS with Cardiac Monitor and 12-lead EKG (9030). Initiate Pulse Oximetry

(9001). Verify a Palpable Pulse. Obtain vitals every 5-10 minutes. Transport to receiving facility, with ALS intercept if not already on-scene.

E

Establish IV with NS, draw labs; do not delay transport for IV access.2 A ALS required for Wide QRS Tachycardia >100 bpm and or with

symptoms of hypoperfusion such as Dyspnea, Chest Pain or ALOC. 12 lead-EKG (9030); transmit when possible to Medical Control. Consider Adenosine (diagnostic) administration 6 mg IV for stable, regular

monomorphic VT Administer Amiodarone 150 mg IV bolus (over 10 minutes). May infuse at 1

mg/minute following conversion. Consider Lidocaine 1 mg/kg IV as an alternate possibility. May infuse at 2-4

mg/minute following successful Cardioversion (9034). For Torsades De Pointes, administer Magnesium 2 gm IV slowly. For deterioration such as with Hypotension (5003), loss of pulse or

consciousness, plan Synchronized Cardioversion (9034), using 100-200 Joules. Premedicate with Midazolam, 0.05-0.1 mg/kg IV (2.5 mg/dose maximum), if feasible and patient is conscious. Be prepared to oxygenate using BVM (4000).

Always repeat a 12-lead EKG following chemical or electrical Cardioversion.

P

** Call Medical Control for Refractory VT or suspected STEMI to determine receiving facility.** M

2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:For witnessed, monitored perfusing Ventricular Tachycardia, try having the patient cough forcefully first.

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/1/14 final 5/8/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines: Cardiac EmergenciesArrhythmia: Wide Complex Tachycardia -5024

For presumed Hyperkalemia (5004) such as patients with end stage renal disease or dialysis, administer Sodium Bicarbonate (1 meq/kg IV over 5minutes).QA 100% review of VT patients requiring Cardioversion. EKGs will be attached to PCR.

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/1/14 final 5/8/2023 page 2 of 2