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The Valley Hospital Mobile ICU
Standing Orders / Communications Failure Orders
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(c) If the rhythm converts, begin continuous Amiodarone 1 mg/min IV/IO infusion after initial bolus is
complete.
(d) If there is any recurrence of the wide-complex tachycardia, continue the sequence at the
previously successful energy level.
1.
If the patient is conscious and requires additional sedation, consider Lorazepam
0.05 mg/kg up to a maximum of 2 mg or Midazolam 0.05 mg/kg up to a maximum
dose of 5 mg based on patient’s clinical presentation and administer if appropriate
.
8.41-7.14 Standing orders for stable narrow-complex tachycardia
(a) The following standing orders are authorized in the event that an adult patient presents with a
stable narrow complex tachycardia:
1. Assess and secure airway;
2. Establish vascular access (IV, in the antecubital fossa, if possible);
3. Perform a patient assessment, including medical history and allergies;
4. Perform a 12-lead electrocardiogram tracing and continue to assess the patient and
monitor the cardiac rhythm;
i. If Wolff-Parkinson-White is identified, go to step 10.
ii. If atrial fibrillation or atrial flutter is identified at any time, and no Wolff-Parkinson-
White is known or suspected, administer Diltiazem 0.25mg/kg IV over 2 minutes
and go to step 10.
5. Attempt vagal maneuver;
6. Administer 6mg Adenosine rapid push via vascular access over a period of one to three
seconds, followed by a 20mL bolus of normal saline solution rapid push via vascular
access;
7. If there is no conversion with 6mg Adenosine, then administer 12mg Adenosine rapid
push via vascular access over a period of one to three seconds, followed by a 20mL
bolus of normal saline solution rapid push via vascular access;
8. If there is no conversion with 12mg Adenosine, then repeat administration of 12mg
Adenosine rapid push via vascular access over a period of one to three seconds,
followed by a 20mL bolus of normal saline solution rapid push via vascular access;