First Due Academy CardiacEMREMTAEMTParamedic

Tachycardia (With Pulse) — Utah 2025 Protocol

Unstable → cardiovert immediately. Stable → identify rhythm, treat by type.

Steps by Cert Level

ALL: Is patient stable or unstable? UNSTABLE (hypotension, AMS, chest pain, shock) → synchronized cardioversion immediately.
PARAMEDIC: NARROW COMPLEX (SVT): Vagal maneuvers first. Then Adenosine 6mg rapid IV push + 20mL NS flush. Repeat 12mg x2 if no conversion.
PARAMEDIC: WIDE COMPLEX (assume VT): Stable → Amiodarone 150mg IV over 10min. Unstable → Synchronized cardioversion 100J biphasic.
ALL: CARDIOVERSION DOSES: SVT/AFib/AFlutter 100–200J | VT with pulse 100J. Sedate first: Midazolam 2.5–5mg IV + Fentanyl 1mcg/kg IV.