504-C VENTRICULAR TACHYCARDIA WITH A PULSE

• NOTE:
  IN PATIENTS WITH PULSELESS VENTRICULAR TACHYCARDIA, SEE SUBPROTOCOL 503-B.

In patients with ventricular tachycardia (of even brief duration) and evidence of cardiac output:

1. Administer Lidocaine 1.0 mg/kg, IV bolus. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)

2. Transportation decision.

3. If Lidocaine does not convert the rhythm, contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Perform Synchronized Cardioversion* using 50-200 joules. Synchronized Cardioversion may be repeated as necessary using 200 joules.

* If the patient is alert prior to performing Synchronized Cardioversion, the patient must first be sedated as follows:

a. Administer Morphine Sulfate 2.0-5.0 mg, IV bolus. Repeat doses of Morphine Sulfate 2.0-5.0 mg IV bolus, may be given as necessary. (Maximum total dosage is 15 mg.)

OR

b. Administer Diazepam 5.0-10 mg, IV bolus. Repeat doses of Diazepam 5.0-10 mg, IV bolus, may be given as necessary. (Maximum total dosage is 20 mg.)

• NOTE:
  IF HYPOTENSION, HYPOVENTILATION, OR STUPOR DEVELOPS OR PERSISTS DURING ADMINISTRATION OF MORPHINE SULFATE, WITHHOLD MORPHINE SULFATE, ELEVATE THE LEGS, AND ADMINISTER NALOXONE 2.0 mg, IV BOLUS.

OPTION B:

Administer Lidocaine 0.5-1.0 mg/kg, IV bolus. Repeat doses of Lidocaine 0.5-1.0 mg/kg, IV bolus, may be given every five minutes up to a maximum dosage of 3.0 mg/kg, and may be followed by an IV drip at a rate of 1.0-4.0 mg/min. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)

• NOTE:
  LIDOCAINE MUST BE USED WITH CAUTION IN PATIENTS OVER 70 YEARS OF AGE AND PATIENTS SUFFERING FROM CONGESTIVE HEART FAILURE, LIVER DISEASE, SHOCK (OF ANY ETIOLOGY), AND/OR POSSIBLE PRIOR ALLERGIC RESPONSE. PARAMEDICS SHOULD ALERT MEDICAL CONTROL TO THESE CONDITIONS, AS THE LIDOCAINE DOSAGE MAY NEED TO BE ADJUSTED ACCORDINGLY.

OPTION C:

Transportation decision.

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