Assess primary ABCDs
1. Pt responsive
2. Pt breathing
3. Pt has a pulse present - Rapid
4. Do not defibrillate a rhythm if there is a pulse. Do not cardiovert if the patient is stable.
Assess secondary ABCDs
1. Secure airway if needed
2. "O2, IV, Monitor"- place on O2, place an IV, and place on a heart monitor
3. Check Vital Signs - if no signs of poor perfusion, then patient is stable
4. Review history and physical exam
5. Get a 12 lead ECG
6. Get a portable Chest X-Ray
Assess Rapid Heart Rate as Narrow or Wide Complex Tachycardia?
Wide if QRS complex is > 0.12 seconds or > 3 small boxes on the ECG srip:
If patient is stable, usually ventricular rate is less than 150 bpm
and no Signs and Symptoms (not even one) are not present or if there are no signs of poor perfusion like chest pain, shortness of
breath, decreased level of consciousness (L.O.C.), decreased BP,
shock, pulmonary congestion, CHF, Acute MI
Amiodarone 150 mg over 10 minutes IV, then hang a drip at 1mg/min for 6 hours, then 0.5 mg/min to a max dose of 2.2 grams in 24 hours.
Less emphasis on these medications:
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Magnesium 1-2 grams over 1-2 hours IV for torsades de points or confirmed hypomagnesium level.
Procainamide 20 mg/min IV drip to max dose of 17 mg/kg, then hang a drip at 1-4 mg/min
Lidocaine 0.5mg/kg IV Q 3-5 minutes to max dose of 3mg/kg. Then, hang a drip at 1-4 mg/min.
