Bonner County EMS System Patient Care Treatment Guidelines: Cardiac EmergenciesArrhythmia: Narrow Complex Tachycardia (SVT) -5022

NARROW COMPLEX TACHYCARDIA (SVT)

Presentation with Symptomatic Narrow QRS Tachycardias Such as PAT or Atrial FibrillationHISTORY

Medications (Aminophylline, Diet pills, Thyroid Supplements, Decongestants, Digoxin)

Diet (caffeine, chocolate) Drugs (nicotine, cocaine,

ephedrine) Past medical history History of palpitations / heart

racing Syncope / near syncope

SIGNS AND SYMPTOMS HR > 100/min QRS < .12 Sec (if QRS > .12 sec,

go to V-Tachycardia Protocol If history of WPW, go to V-tachycardia Protocol Dizziness, CP, SOB Potential presenting rhythm Atrial/Sinus tachycardia Atrial fibrillation / flutter Multifocal atrial tachycardia Nodal reentrant tachycardia Accessory pathway tachycardia

ASSESSMENT Heart disease (WPW,

Valvular) Sick sinus syndrome Myocardial infarction Electrolyte imbalance Exertion, Pain, Emotional

stress Fever Hypoxia Hypovolemia or Anemia Drug effect / Overdose (see

HX) Hyperthyroidism Pulmonary embolus

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial patient contact (2000). Oxygen Administration (9000) as indicated (15L NRB if unstable). R Assist ALS with Cardiac Monitor and 12-lead EKG (9030) if indicated. Pulse

oximetry (9001). Transport to receiving facility.

E Establish IV with NS, draw labs; do not delay transport for IV access.2 A ALS required for persistent, symptomatic Narrow Complex Tachycardia. 12-lead EKG; transmit when possible to Medical Control. For stable tachycardia, consider Valsalva or Vagal maneuvers. For regular rhythm and heart rate above 145 bpm (suspected PAT), administer

Adenosine 6 mg IV rapidly. May repeat up to two more doses of 12 mg each. For irregular rhythm with heart rate above 130 bpm (suspected atrial

fibrillation), administer Diltiazem 0.25 mg/kg IV bolus (maximum dose 20 mg IV). For narrow complex tachycardia with altered mental status or systolic pressure

< 80 mmHg, consider Synchronized Cardioversion starting at 100 Joules (9034). Premedicate with Midazolam, 0.05-0.1 mg/kg IV (2.5 mg/dose maximum) if the patient is conscious. Be prepared to ventilate with BVM to maintain oxygenation and ventilation (4000).

P

** Call Medical Control for Refractory Tachycardia, or Cardiac Arrest. Discuss additional possible medications of Metoprolol 5 mg IV and or Amiodarone 150 mg IV**. M

2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/14/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines: Cardiac EmergenciesArrhythmia: Narrow Complex Tachycardia (SVT) -5022

If patient has a history of WPW or delta waves on the 12 lead EKG, DO NOT administer Adenosine, Calcium blockers (e.g. Diltiazem) or Beta Blockers (e.g. Metoprolol). Amiodarone is a safer choice.Monitor for Hypotension if using Calcium Channel or Beta Blockers.For Asystole following IV Adenosine, coach the patient to cough regularly until the rhythm returns.Document all rhythm changes with monitor strips and obtain strips after each therapeutic intervention.QA 100% review of SVT patients requiring Synchronized Cardioversion.

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/14/2023 page 2 of 2