She denies any other associated symptoms. Initial vitals demonstrate the following:
T: 36, P: 110, BP: 92/54, R: 14, O2: 100%.
The monitor demonstrates the following:
What is your initial step in management?
Synchronized cardioversion
Administer a beta-blocker or calcium channel blocker
Administer adenosine
Identify the underlying cause
The rhythm demonstrates sinus tachycardia. The patient is awake, alert and has stable vital signs. The treatment for sinus tachycardia is identifying the underlying cause (pain, anxiety, hypovolemia, etc.). Administering a beta-blocker or calcium channel blocker in the scenario would unnecessarily blunt cardiac response and affect cardiac output.
Repeat vitals: P: 160, BP: 92/54. You now see the following rhythm on the monitor:
What is your next step in management?
Administer IVF’s
Administration of adenosine 0.1mg/kg with maximum of 6mg dose
The patient is in a stable, narrow complex, tachycardia. This is consistent with supraventricular tachycardia (SVT). Administration of adenosine can be both diagnostic (to confirm SVT) as well as therapeutic (converting patient back to sinus rhythm). Synchronized cardioversion is unnecessary for a stable patient. While administering IVF’s is unlikely to cause any harm, it will not convert patient from this arrhythmia.
Which of the following describes appropriate vagal maneuvers that can be attempted to convert the patient back to normal sinus rhythm?
Carotid massage or valsalva with leg lift
Shoulder massage
Hot water immersion
Cardiac thump
Carotid massage, valsalva maneuvers and cold water immersion (although cold water immersion is less practical), all are maneuvers that can be attempted to convert back to sinus rhythm.
She now feels very light-headed, nauseated, diaphoretic and repeat vitals demonstrate the following: HR: 220, BP: 60/30, O2: 98%, RR: 24.
What is the next step in management?
Valsalva maneuvers
Intubate
Synchronized cardioversion at 0.5 J/kg
Administer a beta-blocker
For narrow complex tachycardia with a pulse, but demonstrating signs of poor perfusion, the treatment is synchronized cardioversion at 0.5 J/kg. You can increase J with subsequent attempts but not to exceed adult dosing/electricity.
