Prehospital management of acute tachyarrhythmias.
Arrhythmias are commonly encountered by emergency medical services (EMS) personnel. The potential seriousness of acute symptomatic arrhythmias necessitates thorough up-to-date training of EMS personnel. The three most common acute tachyarrhythmias, not linked to cardiac arrest, that are observed outside the hospital are paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation with rapid ventricular response (RAF), and perfusing ventricular tachycardia (VT). Ideally, these tachyarrhythmias should be operationally defined in a manner that simplifies, particularly for EMS providers, their diagnosis and treatment. The authors recommend referring to these rhythms as regular narrow-complex tachycardia (presumed PSVT), irregularly irregular narrow-complex tachycardia (presumed RAF), or regular wide-complex tachycardia (presumed VT or aberrantly conducted PSVT). Although the value of treatments such as cardioversion is widely understood, the benefit from others, such as lidocaine, is unclear. Current preferences, recommendations, and concerns regarding the treatment of most arrhythmias outside the hospital reflect the dichotomy that sometimes exists between available evidence and actual practice.
Slovis
Corey M
CM
Department of Emergency Medicine, Vanderbilt University Medical Center and Nashville Fire EMS (CMS), Nashville, Tennessee 37232-4700, USA. corey.slovis@mcmail.vanderbilt.edu
Kudenchuk
Peter J
PJ
Wayne
Marvin A
MA
Aghababian
Richard
R
Rivera-Rivera
Edgardo J
EJ
D000208:Acute Disease; D000241:Adenosine / Q000009:adverse effects / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D013610:Tachycardia / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D014636:Valsalva Maneuver
D000889:Anti-Arrhythmia Agents; D000241:Adenosine