* ABCs                                                             * Assess Vital Signs
* Secure Airway                                              * Review History
* Administer Oxygen                                     * Physical Examination
* Start IV                                                          * Order 12 leads
* Cardiac Monitor , Pulse Oximeter            * Portable Chest X - Ray

Over 1-3 s

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Adenosine
Effect on SVT
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After 1-2  min

May Repeat Once in 1-2 min

Max. total dose
of 17mg/kg

After 15-30 min

Consider:
* Digoxin                                *  Diltiazem
*  Beta Blockers
   (Caution after Verapamil)

Sedation *

If the Wide Complex Tachycardia is known with certainty to be PSVT and BP is
normal / elevated , sequence can include Verapamil.

Carotid sinus pressure is contraindicated in patients with carotid bruits ; Avoid ice water
immersion in patients with Ischemic Heard Disease.

Premedicate - Effective regiments have included a sedative (eg, Diazepam , Midazolam
Barbiturates , Etomidate , Ketamin , Methohexital) with or without analgestic agent
(eg , Fentanyl , Morphine , Meperidine). Many experts recommend anasthesia.

Paramedic Neomi Zvi - Feb. 2000

AHA ; ACLS ; 1994 ; 1-32  -  1-33