This case study was brought to us by a friend and huge supporter of the show that works in an urban EMS service here in Indiana.
You and your partner are called to a grocery store in the middle of the afternoon on a well-being check for a patron of the store. As you approach the customer service desk, you see the patient reclining on a bench and appearing obviously restless and anxious. The patient, an 82yof, states that she has been walking around the store for approximately 30 minutes, and became acutely dizzy and feels “overheated”. After some general questioning, you find that the patient denies any recent illness, and states that she has been eating and drinking normally for herself. This patient has no substantial medical history, and beyond taking a daily vitamin, does not take any home medications. You and your partner remove the patient from a public setting for her privacy before doing a more thorough assessment.
INITIAL VITAL SIGNS AND DIAGNOSTICS
- B/P: 92/56
- HR: 160/Regular
- SpO2: 98% on R/A
- RR: 24/non-labored and shallow
- Blood glucose: 74
- Temperature: 98.2º F
- Skin is pale, warm, and dry
As you are setting up your EKG monitor, your partner initiates IV access, starts a 250ml 0.09% NS bolus and places the patient on a NC @4lpm. This is what you see when your 12-lead spits out.
You deduce that this is a pretty straightforward case of SVT, and proceed to your narrow complex tachycardia protocols, administering 6mg of Adenosine followed with a rapid 20ml NS flush. Your partner had the foresight of hitting “print” on the monitor during the exchange.
After short-lived anxiety from your patient, she begins to feel a significant amount of relief from her symptoms.
POST INTERVENTION FINDINGS
- B/P: 116/72
- SpO2: 99% on 4lpm via NC
- HR: 96
- RR: 18/non-labored and normal depth
Patient transported to local PCI facility without any further incidents of recurring SVT or changes in V/S or mentation.
What do you do to prepare your patients for Adenosine administration? Synchronized cardioversion?
If vital signs and protocols allow, what is your sedation agent of choice for procedures like this? Do you consider sedation and/or analgesia?
What are some clinical markers that help you determine if a rapid rhythm is AFib with RVR, SVT, or VT?
What is the importance of doing a 12-lead prior to giving adenosine?
For more on rapid rhythm diagnosis and treatment, listen to our interview with Eric Allmon.