Patients who presented with a supraventricular tachycardia (SVT) can have potentially dangerous disease for life, and its outcome is often directly related to the care they receive in the ED. Within minutes, the doctor must determine the emergency and support the ABC and confidently and quickly determine the need for interventions. The search for an underlying condition must be launched immediately while trafficking stability of the patient. The synchronized cardioversion indicated for patients often unstable, while a more sophisticated approach is necessary to decipher and manage the patient stable. While SVTs is a frequent cause of ED1 and visits to primary care office2, are infrequently the primary reason the hospital admission.1-3
Traps common facing SVTs
How can you avoid them
1. I have much experience with the distinction of SVT aberrancy of VT - I'm really on top of several criteria that you can use to tell each other.
That's great! Until 54 year old male was sure you had SVT drops of your blood pressure to 50/30 after you give diltiazem and requires aggressive resuscitation and the admission of ICU. There are no criteria that are in evidence throughout the distinction of SVT with aberrancy of VT. When the diagnosis is not 100% known to be SVT, a vast complex arrhythmia should be treated as VT. The medications used to treat SVT (diltiazem, verapamil) can be fatal in a patient with VT.
2. I can not believe that the patient filed a complaint. The adenosine treatment was indicated for the SVT and administered right after he shot at the door.
It is true that adenosine was an appropriate treatment, but patients appreciate prevent side effects of medications. It is good practice to initiate treatment promptly, but takes a minute to include patients in the overall plan and prepare before administering medications that cause a sense of condemnation or imminent death.
3. This lady had psych written all over him - a history of depression, anxiety, and frequent visits to the ED palpitations.
The palpitations routine should not be attributed to anxiety. Often, an ECG and monitoring of the telemetry in the ED but not documented a dysrhythmia registrars supervision or event could Holter. It has been well documented that many patients diagnosed, especially females, with SVT initially with anxiety. Refer to these patients for additional evidence can lead ultimately to a diagnosis, treatment that controls symptoms, and a few visits to the ED.
4. Young people can tolerate rapid heart rates; Never use electrical cardioversion-whipped because those young snappers never seem unstable - a blood pressure of 95/50 is normal for them.
While younger patients may be able to better tolerate rapid ventricular response in SVT, there is still potential for steep deterioration. The atrial fibrillation in WPW syndrome is an inherently unstable rhythm where the heart rates can be 300 bpm and the potential for deterioration in ventricular fibrillation is true. If there is a history of WPW syndrome or ECG results continued with WPW syndrome and atrial fibrillation, do not hesitate in cardiovert if there is any hint of instability hemodynamics.
5. The greatest gentleman with a history of myocardial infarction (MI) was the brevity of breath and an irregular rhythm in ECG with an index of 120. I knew he would not tolerate a heart rate of 120 for very long so the metoprolol administered to control fare.
Unfortunately, this patient had a history of severe COPD in addition to coronary artery disease; ECG showed that the esters (not atrial fibrillation) and the patient had Bronchospasm deep in response to treatment with un-mold. In Estero and NPJT, the best course of action is to treat the underlying SVT precipitated something that your heart rate and avoid medications that are relatively contraindicated. In this case, the treatment of COPD underlying could have relieved the patient's symptoms of shortness of breath and have completed or have delayed the mats.
6. It was a change really busy, she was a healthy young woman who has just come in for a repuesio his allergy medication. She was tachycardic in classification, but did not mention any specific complaints.
The samples are vital vital; tachycardia but the need to be treated and the underlying causes be considered. The story would have further revealed that the symptoms of allergy patients were really short breath because of their significant anemia in the setting of dysfunctional uterine bleeding.
7. I was not sure what to do with this kid he was 4 years with a history of cardiac arrest and Ebstein anomaly. He was slightly tachypneic with a blood pressure in the under-side of normal. Her ECG was difficult to interpret but looked like he was in a preexcitado SVT.
When faced with a dilemma of diagnosis or a complicated case, do not forget that you are backing. See cardiology early and get the expert direction.
8. It was a close regulate complex tachycardia on the monitor and could not see any waves P. While the nurse pull of adenosine, I calculated that it could not hurt to try massage but the carotid.
Do not ninguĂ No damage - even a maneuver vagal simple as massage of the carotid but can be disastrous for patients with a history of stroke or presence of a carotid bruit in the examination. To prevent neurological complications, it is imperative to get a quick medical history and be attentive carotid bruit before starting massage but the carotid. If you want to try a maneuver vagal, invite the patient valsalva.
9. The young woman gave a history of SVT and present with symptoms usually palpitations and dizziness. When I spoke with his cardiologist, he recommended the amiodarone, the first dose was given in the ED.
That young woman was pregnant and in its first quarter. Very few medications used to treat SVT is contraindicated in pregnancy, but it is one of amiodarone. While it is very useful to have input specialist, the provider of emergency medicine must obtain routine tests that can alter the management, even if the specialist does not suggest - a pregnancy test of urine must be ordered in all females of the age of motherhood, especially if they are going to be given medication.
10. The diabetic woman mayor was in digoxin for previously diagnosed atrial fibrillation. She filed today with fatigue. Her ECG showed NPJT and send a level of digoxin that became high gently. Admitted to hospital for closer monitoring.
Their level of digoxin was not the only value was high, their troponin laboratory that was 20. It is true that she was in NPJT, but she also had a lower MI. The review further its ECG also showed lower investment wave T. It is important to review the entire ECG of a careful and systematic way. The diagnosis of an SVT does not exclude other more serious diagnosis.
References
1. ADO of Murman, McDonald AJ, AJ Pelletier, and other visits of the emergency department of the U.S. for supraventricular tachycardia, 1993-2003. MED of emergency Acad. 2007; 14 (6): 578-581. (Retrospective; 550,000 visits related to SVT)
2. Luderitz B pharmacological treatment of Manz M. of supraventricular tachycardia - the German experience. J Cardiol. August 1992: 70 (5): A66-A74. (Review)
3. WB Bain, Yu W, KA of Weis. Trends and results in the hospitalization of older Americans for disorders or cardiac arrhythmias, 1991-1998 of driving. J Geriatr Soc. June 2001, 49 (6): 763-770. (Retrospective; 144,512 downloads)
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