505 SUPRAVENTRICULAR TACHYCARDIA

1. Begin appropriate Basic Life Support Procedures.

2. Begin Cardiac Monitoring, record and evaluate EKG strip.

3. Begin an IV infusion of Dextrose 5% in water (D5W), to keep vein open.

4. Monitor blood pressure every 2-3 minutes.

5. Transportation decision.

6. If the patient has chest pain, other evidence of myocardial ischemia, or signs of shock, administer Adenosine as follows:
   a. 6 mg IV bolus followed with a D5W flush.

   b. Observe EKG monitor for 1-2 minutes for cardioversion.

   c. If PSVT continues, administer 12 mg IV bolus, followed with a D5W flush.

   d. If necessary, 12 mg IV bolus may be repeated once more.

7. If the PSVT persists, and the patient has signs of shock, contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Perform Valsalva (vagal) Maneuver.

OPTION B:

Perform Synchronized Cardioversion* using 100 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 15.00 mg.)
OR

b. Administer Diazepam 5.0-10 mg, IV bolus. Repeat doses of Diazepam 5.0-10.00 mg, IV bolus, may be given as necessary. (Maximum total dosage of 20.00 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 C:

Transportation decision.

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