You are called emergent to a 36-year-old female who feels weak. About 30 minutes ago, while trying to sleep, she felt her heart “racing.” She now complains of chest pain vs. palpitations. Patient denies other medical history or allergies, and only takes birth control. Skin is pink, warm, dry.
1. Baseline vitals and high flow O₂ 2. Vitals and prepare dopamine 3. Place on patches and attempt cardioversion 4. Baseline vitals and apply cardiac monitor
Answer: Baseline vitals including a 4-lead monitor is most important for this patient.
She is stable. Vitals: BP 122/80, HR 160, RR 22, SpO₂ 99% RA. Initial EKG shows SVT. IV and 12-lead started, unremarkable aside from rate.
1. Perform vagal maneuvers 2. Give 6 mg adenosine 3. Give 12 mg adenosine 4. Place bag of ice on face
Answer: Vagal maneuvers (and O₂ as needed) are the next step for stable SVT.
Vagal maneuvers unsuccessful.
1. Cardioversion 2. Administer 6 mg adenosine rapid IVP 3. Administer 12 mg adenosine rapid IVP 4. Transport only
Answer: Give 6 mg adenosine rapid IVP. Expect transient side effects such as chest pain or dyspnea.
Adenosine 6 mg given, no effect. Patient reports chest discomfort but recovers quickly.
1. Repeat 6 mg adenosine 2. Give 12 mg adenosine 3. Sedate and cardiovert 4. Transport only
Answer:12 mg adenosine is the next recommended step for stable SVT.
After adenosine, patient shows transient bradycardia on monitor.
1. Pace 2. Administer atropine 3. Observe only, transient 4. Assess BP first
Answer: This bradycardia is transient after adenosine and typically self-resolves without intervention.
Patient briefly converted but then slumps, unresponsive, HR 180 bpm.