AnthonyM83 Posted May 17, 2007 Share Posted May 17, 2007 Speaking of SVT...have you guys ever walked in on a patient and just thought "SVT" immediately...? This is by no means scientific...but I guess just categorizing patients...like when you walk in and think "respiratory distress". I'm not sure what gave it away...I think it was that the call was for chest pain (none on arrival) but she looked pale, far away look, slow to respond, lethargic even, but fully oriented. Link to comment Share on other sites More sharing options...
Imagine89 Posted May 17, 2007 Share Posted May 17, 2007 Yeah sometimes. If it is SVT, am I correct in assuming that this patient is getting adenosine ASAP? I'm just a lowly highschool basic, so I could be wrong. Link to comment Share on other sites More sharing options...
AZCEP Posted May 18, 2007 Share Posted May 18, 2007 Look at the strip. Based on the patient's condition, and the ECG provided, this patient is not going to be receiving any medications until after the heart rate is controlled. Wide complex tachycardia + unstable patient = cardioversion Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 18, 2007 Share Posted May 18, 2007 So how do you correct HR if you don't have cardioversion in your county? I was told adenosine is what corrects the HR...if you slowed the rate down, then you don't need adenosine in the first place. But those are just verbal explanations I've gotten...I haven't studied ALS drugs much, yet...working on EKGs still. Link to comment Share on other sites More sharing options...
ericenglund Posted May 18, 2007 Share Posted May 18, 2007 So how do you correct HR if you don't have cardioversion in your county? I was told adenosine is what corrects the HR...if you slowed the rate down, then you don't need adenosine in the first place. But those are just verbal explanations I've gotten...I haven't studied ALS drugs much, yet...working on EKGs still. Right. Adenosine is indicated in rapid narrow complex tachycardias. It won't convert V-Tach as far as I know. You could try amiodarone techinically but I'd go with a good 100J synch. cardioversion. Also, I think(but am having a midnight brain fart) the new ACLS guidelines want us to do electrical therapy without delay. Link to comment Share on other sites More sharing options...
AZCEP Posted May 18, 2007 Share Posted May 18, 2007 Adenosine is indicated for RE-ENTRY narrow complex tachycardias. Being able to identify the re-entry portion can be challenging, so most just fall back to the narrow complex. It will be ineffective for this patient, and will take time away from what is needed-->immediate conversion of the rhythm. Unfortunately for your situation Anthony, your medics are severly hamstrung if they are not allowed to cardiovert. This is one of the simplest, most effective, least dangerous modalities to treat these patients. All of the different medications carry much greater risk of worsening the situation. Procainamide or Amiodarone can be effective for this rhythm, but the patient doesn't really have the time to wait for them to reach an effective threshold. Link to comment Share on other sites More sharing options...
ericenglund Posted May 18, 2007 Share Posted May 18, 2007 dang 90 minute edit rule. didnt mean to say "rapid narrow complex tachycardia," on my previous post haha. Obviously a bit redundant, but hey, it was midnight. Link to comment Share on other sites More sharing options...
CBEMT Posted May 18, 2007 Share Posted May 18, 2007 LOL!! Yeah, I think I'd like to hear the rationale behind that one too! :munky2: I smell a cookbook..... :roll: Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 19, 2007 Share Posted May 19, 2007 Is that rhythm SVT? I was assuming so, b/c someone mentioned it was. Is there then a narrow complex tachycardia within that rhythm or are they the same thing? LA is working on getting cardioversion (we'rer way behind in the times)...but for now I've seen adenosine correct SVT everytime it's been used...immediately. Link to comment Share on other sites More sharing options...
AZCEP Posted May 19, 2007 Share Posted May 19, 2007 It may well be, but it is more common for this rhythm to be ventricular tachycardia. Without cardioversion you have to be extremely careful which route you take. The AV blocking agents (Cardizem, B-blockers, Adenosine) can make this situation worse. Lidocaine, Procainamide, and Amiodarone would be the most useful, safest agents to choose from. Because of this patient's instability, none of these is a great choice. Synchronized cardioversion may be challenging to accomplish as well. Some monitors have difficulty synchronizing with wide QRS complexes. In that instance, turn the "SYNC" off and defibrillate. This patient needs rapid resolution of this rhythm. Link to comment Share on other sites More sharing options...
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