EMS Protocol of the Week - Ventricular Tachycardia with a Pulse / Wide-Complex Tachycardia of Uncertain Type (Adult)

Happy Tachy Tuesday!

Another guest post for the week where we will be discussing the EMS protocol for Ventricular Tachycardia with a Pulse / Wide-Complex Tachycardia of Uncertain Type.

First question: is this patient stable or unstable? If this patient is hypotensive, altered, or has signs of hypoperfusion, this is an unstable patient. Standing Order will allow paramedics on scene to perform SYNCHRONIZED CARDIOVERSION up to 4 times (first 100J, then 200J, then 300J, then 360J). If that does not work, they will administer Amiodarone 150mg IV.

If the patient is stable, Standing Order allows administration of Amiodarone 150mg IV or Lidocaine 1mg/kg. If persistence of stable V-Tach after one agent is given, they can give the other one.

For both Stable and Unstable V-Tach, OLMC will be called if nothing above worked for authorization of three options: administration ofMagnesium Sulfate 2g IV, Calcium Chloride 1g IV if suspicious for hyperkalemia or calcium channel blocker OD, or Sodium Bicarb 44-88 mEq IV if suspicious for acidosis.

Check out www.nycremsco.org or the protocol binder on North Side for more.

Sincerely,

Joseph Liu, DO

Chief Resident, Emergency Medicine PGY-3