Protocol 2-946 - Ventricular Tachycardia

CMH EMS & MIH Protocols

EMR:

Calm and reassure patient. Ensure patient does not exert themselves.

Oxygen to maintain SpO2 between 94-99%.

Adult:	Pediatric:
Heart rate greater than 150: Apply Combo Pads anterior / posterior	Child with heart rate greater than 160 OR infant with heart rate greater than 220: Consider applying Combo Pads anterior / posterior.

RN:

Ensure completion of all applicable items above.

Obtain 12-Lead ECG as soon as able.

Consider IO NS/LR. Do not delay for IV/IO if symptomatic.

Adult:	Pediatric:
Heart rate greater than 150: Symptomatic: Conscious: Consider Protocol 2-660 - Pain Control. Synchronized Cardioversion 125 J. If unsuccessful, increase to 200 J. Asymptomatic: Amiodarone 150 mg IV/IO over 10 min. Mix in 100 ml NS. Repeat as needed (max 2.2 gm over 24 hr). If converted by Amiodarone, consider drip at 1 mg/min. QTc greater than 0.300 sec: Magnesium Sulfate 1-2 g IV/IO in NS over 15-20 min.	Child with heart rate greater than 160 OR infant with heart rate greater than 220: Symptomatic: Conscious: Consider Protocol 2-660 - Pain Control. Synchronized Cardioversion 0.5-1 J/kg. Click "calculate" to get dose. Consider contacting MEDICAL CONTROL for Amiodarone as dosed in asymptomatic below. Asymptomatic. Contact MEDICAL CONTROL for: Consider Adenosine 0.1 mg/kg (max 6 mg). May repeat at 0.2 mg/kg (max 12 mg). Click "calculate" to get dose. Click "calculate" to get dose. Consider Amiodarone 5 mg/kg IV/IO over 20-60 min (max 150 mg). Click "calculate" to get dose. Consider Protocol 2-660 - Pain Control. Consider Synchronized Cardioversion 0.5-1 J/kg. Click "calculate" to get dose.

Adult:

Pediatric:

Heart rate greater than 150:

Symptomatic:

Conscious: Consider Protocol 2-660 - Pain Control.
Synchronized Cardioversion 125 J. If unsuccessful, increase to 200 J.

Asymptomatic:

Amiodarone 150 mg IV/IO over 10 min. Mix in 100 ml NS. Repeat as needed (max 2.2 gm over 24 hr). If converted by Amiodarone, consider drip at 1 mg/min.

QTc greater than 0.300 sec: Magnesium Sulfate 1-2 g IV/IO in NS over 15-20 min.

Child with heart rate greater than 160 OR infant with heart rate greater than 220:
Symptomatic:

Conscious: Consider Protocol 2-660 - Pain Control.
Synchronized Cardioversion 0.5-1 J/kg.

Click "calculate" to get dose.

Consider contacting MEDICAL CONTROL for Amiodarone as dosed in asymptomatic below.

Asymptomatic. Contact MEDICAL CONTROL for:

Consider Adenosine 0.1 mg/kg (max 6 mg). May repeat at 0.2 mg/kg (max 12 mg).

Click "calculate" to get dose.

Click "calculate" to get dose.

Consider Amiodarone 5 mg/kg IV/IO over 20-60 min (max 150 mg).

Click "calculate" to get dose.

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.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914151 - Medical-Ventricular Tachycardia (With Pulse)

Citations:

Protocol 9-010 - References
American Heart Association, 2020
NASEMSO Medical Directors Council, 2017

Change Log:

Date	Link to previous version	Description of change
10/04/13	pdf	Added rates and consider to Combo Pads.
10/04/13	pdf	Added rates to Combo Pads. Added symptomatic to ALS treatments.
11/11/13		Fixed Mag Sulfate dose over 5 min to over 15-20 min (assume it was a typo).
06/27/16	pdf	Added note that IV access must be in an AC space (left is preferred).
08/24/17	pdf	Removed Ativan and Procainamide.
09/20/17		Increased Lidocaine from 0.5 to 1 mg/kg. Modified pediatric Versed dosages.
11/11/17	pdf	Replaced Versed and Fentanyl with reference to Protocol 6-050 - Control of Pain for pre-cardioversion.Removed directions to mix Amidoarone and Mag Sulfate.
04/06/20		Added content from old Protocol 2-100 - Tachycardia Wide Stable. Changed indication for Mag Sulfate from QT/RR > 0.4 to QTc > 0.3 due to ease of identifying those values by paramedics. RR is not redily availablemust be measured by hand where QTc is measured by the LifePakprinted on the 12-lead.
04/06/20		Added content (without substantive modification) from old Protocol 2-110 - Tachycardia Wide Unstable.
04/06/20	pdf	Added content (without substantive modification) from old Protocol 2-130 - Ventricular Ectopy.
05/16/20	pdf	Added additional Lidocaine dose if over 70 years old. Dose reduction by 50% was already in the medication protocol for Lidocaine.
02/19/21	pdf	AHA 2020 updates to this protocol include an Amiodarone drip after conversion and the option for Adenosine for pediatric patients.
06/06/21	pdf	Moved to emsprotocols.online
10/16/21	pdf	Added comment to mix Mag Sulfate with NS per protocol committee on 5/26/21 and Dr Nicholes on 12/8/20. Also, removed Lidocaine as a treatment option for VTach with a pulse per Dr. Nicholes on 8/5/21.
11/30/21		Updated link to Adenosine.
11/30/21		Updated link to Albuterol.
11/30/21		Updated link to Amiodarone.
02/25/22	pdf	Removed typo indicating 125 J/kg cardioversion (now 125 J). Added details of mixing Amiodarone in 100 ml NS per protocol committee on 1/26/22.
02/28/22		Updated link for Sodium Bicarb.
03/16/23	pdf	Clarified RN and medic roles. Added CP.
03/17/23		Updated link to NS.
03/19/23		Changed link for MagSulftate.
03/19/23		Changed link for LR.

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Protocol 2-946 - Ventricular Tachycardia

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: