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EMR
EMT
AEMT
Paramedic
Extended
Narrow Complex Tachycardia
Narrow Complex Tachycardia
Universal Patient Assessment
Oxygen
Titrate SpO2 to 94%
Adult Airway Protocol
Palpable Pulse?
Appropriate Arrest
Protocol
Cardiac Monitor
12-Lead ECG
If
EMT
or STEMI, transmit
Adult IV/IO
PSVT
Heat Rate >150
A-fib/A-flutter
Heart Rate >150
PSVT
A-fib/A-flutter
Heart Rate >150
Synchronized Cardioversion
at
Manufacturer’s Doses
Consider ketamine 0.4mg/kg IM
prior, but do not delay
cardioversion
If patient converts at any
time with cardioversion,
reassess, monitor,
oxygenate, and transport.
Fluid Bolus
1000mLNormal Saline
Repeat x1 if lung
sounds are clear.
Vagal Maneuvers
Adenosine
6mg rapid IVP
Adenosine
12mg rapid IVP
May repeat once if there was
any change following first 12
Consider screening for
the underlying cause of
the tachycardia.
Vagal Maneuvers:
Valsalva
SVT originating in the
atria (A-fib/A-flutter)
does not respond to
Adenosine.
Only base treatment on the
palpable pulse rate, not the
monitor’s rate!
No
Stable
Unstable
Narrow Complex Tachycardia
Manufacturer’s Doses
Zoll – 75 J initial
120, 150, 200, 200, 200
Physio – 50-100 J initial
150, 200, 200, 200, 200
Philips – 50-100 J initial
150, 200, 200, 200, 200