Next up in our dysrhythmia marathon is an oldie but a goodie – SVT! Again, Standing Orders lead off with instructions for synchronized cardioversion for unstable patients. For stable SVT, paramedics will give adenosine by Standing Order in the standard 6-12-12 strategy you all know and love in the ED. If hard rebooting the patient’s heart three times doesn’t fix the rate, OLMC will be called for additional orders. For Medical Control Options, you have access to the same diltiazem and amiodarone that were there for you in the atrial fibrillation/atrial flutter protocol from last week. Are either of those worth it? Who knows? You’re in charge, doc!
At this point, you might be thinking, “Dave, how can I know over the phone that the patient is really in AFib/Aflutter/SVT/etc.? Also, these emails are amazing! And you’re so funny!” Well thank you for the complements, firstly. But to answer your excellent question, different people are going to have different levels of confidence or trust in their paramedics. Processing information over the phone can be tricky since you can’t actually see what the field providers are seeing. But if there’s ever any uncertainty, remember that there are systems in place for transmitting EKGs! Or if that feels like too much, you can just ask about the tracing! Is the rhythm narrow complex? Regular? What’s the rate? Gather as much info as you need, and make your decision from there.
And if the complex is wide? Well, you’ll just have to stay tuned and find out! Or check out www.nycremsco.org or the protocol binder for spoilers!
Dave