Question

A monitored patient in the icu developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. the patient’s blood pressure is 128/58 mm hg, the petco2 is 38 mm hg, and the pulse oximetry reading is 98%. there is vascular access in the left arm, and the patient has not been given any vasoactive drugs. a 12-lead ecg confirms a supraventricular tachycardia with no evidence of ischemia or infarction. the heart rate has not responded to vagal maneuvers. what is your next action?

Answer 1

The next recommended intervention is the adenosine 6mg IV push. Adenosine is the main drug used in the action of steady narrow complex SVT or as called as supraventricular Tachycardia. It can now also be used for even monomorphic wide complex tachycardia. When given as a rapid IV bolus, adenosine slows cardiac transmission affecting conduction through the AV node. The quick bolus of adenosine also disturbs return SVT initiating the pathways over the AV node and restores sinus rhythm in patients with SVT.The initial dose of adenosine should be 6 mg accomplished fast over 1-3 seconds surveyed by a 20 ml NS bolus. If the patient’s beat does not change out of SVT within 1 to 2 minutes, a second 12 mg dose may be given in similar fashion. Determinations must be finished to manage adenosine as rapidly as likely. A lesser primary dose of 3mg should be used for patients captivating dipyridamole or carbamazepine as these two prescriptions potentiate the effects of adenosine. Also, lengthy asystole has stood become with the use of normal doses of adenosine in heart transfer patients and central line use. Consequently, the lower dose 3mg may be measured for patients with a central venous line or a history of heart transfer.