Protocol 2-858 - Supraventricular Tachycardia

CMH EMS & MIH Protocols

EMD:

• No specific protocol.

EMR:

• Calm and reassure patient. Ensure patient does not exert themselves.
• Oxygen to maintain SpO2 between 94-99%.
• Apply cardiac monitor limb leads.

• Adult:	Pediatric:
  Rate greater than 150: Apply combo pads anterior / posterior	Rate greater than 180 (child) or 220 (infant): Apply combo pads anterior / posterior

EMT:

• Ensure completion of applicable items above.
• Consider assisting ALS with capnography.

AEMT:

• Ensure completion of applicable items above.
• IV LR in AC (left is preferred) with pigtail extension with 18 ga or greater.

RN:

• Ensure completion of all applicable items above.
• Obtain 12-Lead ECG.
• Consider IO LR. Do not delay IV/IO if symptomatic.
• Determine and treat the cause of tachycardia before medication administration (i.e. infection, dehydration, pain, etc.).

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• Adult:
  Unstable/symptomatic and rate greater than 150: Conscious: Consider Protocol 2-660 - Pain Control. Synchronized Cardioversion 125 J. If unsuccessful, repeat at 200 J. Stable/asymptomatic and rate greater than 150: Vagal maneuver: Have patient blow on 10 ml syringe to move the plunger for 15 seconds while sitting and immediately place supine and elevate feet afterward. Consider Cardizem as an equal choice to Adenosine when treating SVT. If using Cardizem use standard dosing as outlined in A-Fib/A-Flutter section below Regular rhythm (not A-Fib, A-Flutter, or WPW): Adenosine 6-12 mg RAPID IV/IO. If ineffective, second dose at 12 mg. Consider Cardizem, Amiodarone, or Synchronized Cardioversion. A-Fib or A-Flutter: Cardizem 0.25 mg/kg (max 20 mg) IV/IO over 2 min. Click "calculate" to get dose. May repeat after 15 min at 0.35 mg/kg (max 25 mg) IV/IO over 2 min. Click "calculate" to get dose. If rate controlled with Cardizem bolus, begin drip at 10 mg/hr. WPW: Amiodarone 150 mg IV/IO over 10 min. May repeat at 150 mg over 10 min if tachycardia returns (max 300 mg). If rate controlled with Amiodarone bolus, begin drip at 1 mg/min.
  Pediatric:
  Vagal maneuver: Place bag of ice on the patient’s face for 15 seconds while sitting and immediately place supine and elevate feet afterward. Unstable/symptomatic and rate greater than 180 (child) or 220 (infant): Adenosine 0.1 mg/kg (max 6 mg) RAPID IV/IO. Click "calculate" to get dose. If ineffective, second dose at 0.2 mg/kg (max 12 mg). Click "calculate" to get dose. Consider Protocol 2-660 - Pain Control. Consider Synchronized Cardioversion 0.5-1 J/kg. Subsequent Cardioversion should be at 2 J/kg. Click "calculate" to get dose. Stable/asymptomatic and rate greater than 180 (child) or 220 (infant): Consider contacting MEDICAL CONTROL: Consider Adenosine 0.1 mg/kg (max 6 mg) RAPID IV/IO. Click "calculate" to get dose. If ineffective, second dose at 0.2 mg/kg (max 12 mg). Click "calculate" to get dose. Consider Cardizem. Consider Protocol 2-660 - Pain Control. Consider Synchronized Cardioversion 0.5-1 J/kg. Click "calculate" to get dose.

• Consider and correct treatable causes: Hypovolemia, hypoxia, hypo/hyperkalemia, hypothermia, hypoglycemia, acidosis, tension pneumothorax, toxins, thrombosis, and cardiac tamponade

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.

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