ACLS Megacode Scenario 1: Supraventricular Tachycardia (SVT)

[Music] a 23 year old woman presents to the ed walking accompanied by her husband she complains that her heart is pounding too fast she states that her symptoms started approximately 20 minutes ago she is pale and complains of feeling weak she denies having had similar symptoms before you take her to a room with a monitored bed obtain vital signs and hook her up to the cardiac monitor [Music] so which rhythm is this [Music] this is supraventricular tachycardia svt the rhythm is rapid and regular and the qrs complexes are narrow signifying that the rhythm is originating above the av node does this patient require supplementary o2 [Music] no the patient's spo2 is 96 and she has no complaint of shortness of breath you would give oxygen if the patient's spo2 was less than 94 if the patient showed signs of hypoxemia or if the patient had signs or symptoms of cardiac ischemia or stroke would you characterize the patient as stable or unstable the patient is stable blood pressure is adequate the patient is alert and she has no symptoms or signs of shock or ischemia you ask a colleague to insert an iv and call for a 12-lead ecg what other intervention might you try vegal maneuvers what are some contraindications to carotid massage presence of a carotid brute recent history of stroke tia or mi known cardiac stenosis greater than 50 percent history of ventricular arrhythmias or symptomatic brady arrhythmias you find no contraindications to carotid massage you perform carotid massage for 5 seconds over the point of maximal carotid impulse on both the right and left sides with a 30 second break in between sides the patient's heart rate decreases transiently however it increases back to 180 bpm soon after you have performed the vehicle maneuver what is your next intervention administer adenosine what is the recommended initial dose of adenosine the initial dose recommended is six milligrams rapid iv push what is the proper technique for administration of adenosine the patient should have an iv of normal saline ns running wide open a syringe of 20 milliliters of ns should be prepared the adenosine is injected rapidly into the port closest to the patient followed immediately by the 20 milliliter bolus of ns in the same port the patient's iv arm should be raised above the level of the patient's heart to speed drug circulation some clinicians like to use a stop to administer adenosine after administration of adenosine six milligram you watch the cardiac monitor and note that the patient's rhythm slows there is a brief period of asystole the patient complains of shortness of breath chest discomfort and flushing how should you treat the asystole there is no need to treat simply observe adenosine has a very short half-life and the asystole will last only seconds although it may feel like forever for you and the patient it is a good idea to warn the patient of the unpleasant side effects of adenosine before administration which may include those mentioned as well as lightheadedness or dizziness a metallic taste in the mouth nausea diaphoresis and impending sense of doom what is your next intervention give adenosine at double the dose 12 milligram utilizing the same technique following the second dose of adenosine the cardiac monitor shows that the patient's rhythm has converted to normal sinus rhythm nsr vital signs are stable and the patient states all symptoms have resolved what else should be done for this patient [Music] 12 lead ecg if not already done blood work to check for an underlying cause of the arrhythmia such as an electrolyte imbalance counsel the patient to avoid stimulants such as caffeine consider referral to a cardiologist observe the patient to ensure the arrhythmia does not reoccur when adenosine wears off ask the patient to follow up with their family physician and to return immediately if symptoms reoccur you

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Id: vDHeCw4_-xE

Length: 6min 38sec (398 seconds)

Published: Tue Oct 20 2020