Adult Tachycardia Narrow Complex (≤ 0.11 sec) History Differential · Medications · Rate > 150 · Heart disease (WPW, Valvular) (Aminophylline, Diet pills, Thyroid · Systolic BP < 90 · Sick sinus syndrome supplements, Decongestants, · Dizziness, CP, SOB, AMS, · Digoxin) Diaphoresis · · Diet (caffeine, chocolate) · CHF · Exertion, , Emotional · Drugs (, ) · Potential presenting rhythm · · Past medical history Atrial/ · · History of / heart racing Atrial / flutter · or · / near syncope Multifocal · Drug effect / Overdose (see HX) · · Pulmonary embolus Unstable / Serious Signs and Symptoms Procedure NO HR Typically > 150 YES

B 12 Lead ECG Procedure

I IV Procedure P IO Procedure P P Cardiac Monitor

Regular Rhythm Irregular Rhythm (SVT) ( / Flutter) Adult Cardiac Section Protocols Adult Cardiac Section P Attempt Vagal Maneuvers Exit to Appropriate Protocol P Rhythm Converts YES

NO

P YES Rhythm Converts Single lead ECG able to diagnose and treat NO 12 Lead ECG not necessary to diagnose and treat, but preferred Rhythm Converts YES when patient is stable. NO

P

P

Rhythm Converts / 12 Lead ECG Procedure Rate Controlled YES B

NO Notify Destination or Contact Medical Control

Revised Protocol 16 10/30/2013 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS Adult Tachycardia Narrow Complex (≤ 0.11 sec) Adult Cardiac Section Protocols Adult Cardiac Section

Pearls · Recommended Exam: Mental Status, Skin, Neck, Lung, Heart, Abdomen, Back, Extremities, Neuro · Most important goal is to differentiate the type of tachycardia and if STABLE or UNSTABLE. · If at any point patient becomes unstable move to unstable arm in algorithm. · Symptomatic tachycardia usually occurs at rates of 120 -150 and typically ≥ 150 beats per minute. Patients symptomatic with heart rates < 150 likely have impaired cardiac function such as CHF. · Serious Signs / Symptoms: Hypotension. Acutely altered mental status. Signs of / poor perfusion. with evidence of (STEMI, inversions or depressions.) Acute CHF. · Search for underlying cause of tachycardia such as fever, , dyspnea, etc. · If patient has history or 12 Lead ECG reveals Wolfe Parkinson White (WPW), DO NOT administer a (e.g. Diltiazem) or Beta Blockers. Use caution with and give only with defibrillator available. · Typical sinus tachycardia is in the range of 100 to (200 - patient’s age) beats per minute. · Regular Narrow-Complex Tachycardias: Vagal maneuvers and adenosine are preferred. Vagal maneuvers may convert up to 25 % of SVT. Adenosine should be pushed rapidly via proximal IV site followed by 20 mL Normal Saline rapid flush. Agencies using both calcium channel blockers and beta blockers need choose one primarily. Giving the agents sequentially requires Contact of Medical Control. This may lead to profound / hypotension. · Irregular Tachycardias: First line agents for rate control are calcium channel blockers or beta blockers. Agencies using both calcium channel blockers and beta blockers need choose one primarily. Giving the agents sequentially requires Contact of Medical Control. This may lead to profound bradycardia / hypotension. Adenosine may not be effective in identifiable atrial fibrillation / flutter, yet is not harmful and may help identify rhythm. · Synchronized Cardioversion: Recommended to treat UNSTABLE Atrial Fibrillation, and Monomorphic-Regular Tachycardia (VT.) · Monitor for hypotension after administration of Calcium Channel Blockers or Beta Blockers. · Monitor for respiratory depression and hypotension associated with . · Continuous oximetry is required for all SVT patients. · Document all rhythm changes with monitor strips and obtain monitor strips with each therapeutic intervention.

Revised Protocol 16 10/30/2013 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS