Delaware EMS protocols,
in your pocket.

Indications for the Unstable Tachycardia protocol

Wide complex tachycardia (QRS > 0.12 sec) presumed to be VT at a rate exceeding 150 BPM, OR narrow complex tachycardia (QRS < 0.12 sec) other than sinus tachycardia at a rate exceeding 150 BPM. There should be no evidence of trauma, hypovolemia, fever, or sepsis.

Rhythm check interval and maximum pause duration during CPR

Compressions should be paused to check rhythm every two minutes for no more than 5–10 seconds. The defibrillator should be charged prior to the rhythm check to minimize the pause.

STEMI protocol: When must an IV be established BEFORE giving NTG?

An IV must be established prior to NTG administration when the patient's systolic BP is less than 120 mmHg. NTG should also be used cautiously in patients not currently prescribed NTG.

You are treating a patient with suspected ACS who has a systolic BP of 108 mmHg. According to the protocol, what must be done BEFORE administering nitroglycerin?

• Administer 324 mg aspirin PO first, then give NTG without any further requirements
• ✓ Establish an IV prior to NTG administration
• Obtain a 12-lead ECG and transmit it to the receiving facility
• Contact Medical Control for permission to administer NTG

The protocol states that an IV must be established prior to NTG administration for patients with a systolic BP less than 120 mmHg. Since this patient's SBP of 108 mmHg is below 120 mmHg, IV access is required before giving nitroglycerin.

You are treating a stable patient with a wide complex tachycardia at a rate of 165 BPM, presumed to be ventricular tachycardia. The patient's systolic BP is 102 mmHg. Which intervention is indicated per protocol?

• Administer 6 mg adenosine IV rapidly
• ✓ Administer 150 mg amiodarone IV over 10 minutes
• Administer 0.25 mg/kg diltiazem IV over 2 minutes
• Perform synchronized cardioversion immediately

Per the protocol, a wide complex tachycardia (QRS > 0.12 sec) at a rate exceeding 150 BPM in a stable patient (SBP > 90 mmHg) is treated with 150 mg amiodarone IV infused over 10 minutes. Adenosine and diltiazem are indicated for narrow complex tachycardias, not wide complex VT.