Ventricular Tachycardia (Adult)
 
• Confirm Ventricular Tachycardia
- VT >30sec
- QRS >0.12sec
- Rate >100
- Mostly regular
- A-V dissociation / absence of p waves
   
Is the Pt Stable: Adequately Perfused or Unstable / Rapidly Deteriorating?
   
Stable: Adequately Perfused
   
Amiodarone infusion 5mg/kg IV (max. 300mg) over 10 to 20 minutes, once only via:
• Syringe Pump,
• Spring Loaded Infusion Device or
• Adult Giving Set
Mx as per VT: Unstable if Pt deteriorates
Stop
Only dilute Amiodarone with Dextrose 5%
Do not administer Amiodarone if suspected Tricyclic Antidepressant Medication Overdose. Manage as per Overdose: TCA
 
   
Unstable / Rapidly Deteriorating
   
Synchronised cardioversion
Sedate:
Midazolam 2.5mg IV
Repeat Midazolam 2.5mg IV 2 minutely, until pt does not respond to verbal stimuli but does respond to pain
Cardioversion:
Biphasic 150J (Monophasic 200J)
If unsuccessful repeat using Biphasic 150J (Monophasic 360J) if required
         
Loss of output
Mx per appropriate CPG
 
 
Reversion
• Narrow complex
- Amiodarone infusion as in VT: Adequately Perfused
(if not already running)
• Other rhythms
- Mx as per appropriate CPG
     
Special Notes
A Pt eye opening to pain but not to voice commands would also be likely to be making incomprehensible sounds and making purposeful movements in response to pain, i.e. a GCS of 9, (E2, V2, M5). Sedation should be used cautiously in these Pts
The effectiveness of the Pt’s respirations should be continuously monitored.
Amiodarone and Fentanyl have the potential to interact adversely. Concurrent administration should be avoided. If Fentanyl has already been administered, monitor the pt closely when administering Amiodarone
 
General Care
ALS /QAP crews should consider MICA R/V vs transport to appropriate hospital as these Pts are dynamic and have a potential to deteriorate.
Pt presenting symptomatic and poorly perfused is likely to require synchronised cardioversion prior to Amiodarone administration.