Sandbox/nct fire

First Initial Rapid Evaluation of Suspected Narrow Complex Tachycardia

Shown below is an algorithm for the First Initial Rapid Evaluation (FIRE) of suspected NCT

Identify cardinal signs and symptoms that increase the pretest probability of NCT ❑ Palpitations (Most common presentation) ❑ Tachycardia ❑ Hypotension ❑ Loss of consciousness ❑ Severe dyspnea

❑ Unstable patient

❑ Stable patient

If the rhythm isn't sinus: ❑ Urgent DC cardioversion

If the rhythm is sinus: ❑ Control the rate: ❑ IV metoprolol (2.5 to 5 mg over 2 minutes up to a maximum of 15 mg) ❑ Treat the underlying cause

Continue with the diagnostic approach

❑ Assess airway, breathing, and circulation (ABC) ❑ Administer oxygen if necessary

First Initial Rapid Evaluation of Suspected Tension Pneumothorax

Shown below is an algorithm for the First Initial Rapid Evaluation (FIRE) of suspected tension pneumothorax.

Identify cardinal signs and symptoms that increase the pretest probability of tension pneumothorax ❑ Sever dyspnea ❑ Chest pain ❑ Cyanosis ❑ Decreased level of consciousness (in late stages)

Identify any alarming signs or symptoms ❑ Jugular venous distension ❑ Tachycardia ❑ Hypotension ❑ Severe dyspnea

Unstable patient

❑ Stable patient

❑ Assess airway, breathing, and circulation

Proceed with immediate needle decompression in the 2nd intercostal space, midclavicular line of affected hemithorax

Continue with the diagnostic approach

❑ Insert chest drain immediately after needle decompression