Mon25October0844PM 5

You are asked to review urgently a 24-year-old male who has presented to the Emergency department after admitting to drinking 15 units of alcohol and taking 2 ecstasy tablets tonight. He is alert and orientated however is complaining of palpitations. He denies any chest pain or shortness of breath.

His observations are: HR 180 regular, BP 115/80 mmHg, RR 18 & O2 99% room air. An ECG is performed and demonstrates an atrioventricular nodal re-entry tachycardia (SVT).

What treatment option would you first initiate?

(Please select 1 option)

Adenosine 12 mg IV

Amiodarone 300 mg IV

Vagal manoeuvres Correct

Verapamil 5 mg IV

Adenosine 6 mg IV

Explanation

SVT is an umbrella term for any arrhythmia that arises from above the ventricles that technically encompasses a range of conditions including atrial fibrillation; however is generally used for atriovenricular nodal re-entry tachycardias.

The more common age of presentation is in the 20s and alcohol and drugs are increasingly found to be precipitating factors. As with any unwell patient, early evaluation of ABC is paramount. The Resuscitation Council guidelines advise to decide upon management strategies by initially looking for features of decompensation:

Hypotension <90

Chest pain

Shortness of breath, and

Reduced GCS.

In this scenario there are no adverse signs and as such vagal manoeuvres are indicated. Commonly these can include blowing into a syringe and previously carotid sinus massage, however it is now thought that CSM could possibly dislodge emboli clots, and as such is not recommended for use by non-cardiologists.

If there is no success, adenosine is the drug of choice with the initial dose 6 mg then escalating to 12 mg.

If signs of decompensation were evident the patient would require urgent DC cardioversion, with anaesthetic support required.

Amiodarone is not a first line for regular narrow complex treatment, with adenosine and verapamil being first and second line pharmacological treatments.

Answer Statistics

1

1%

2

3%

3

85%

4

2%

5

12%

Times answered: 272