What?s Your Diagnosis? Supraventricular Tachydysrhythmias in the Emergency Department
July 20, 2020


Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Ventilator Management of Adult Patients in the Emergency Department right.

Case Presentation: Supraventricular Tachydysrhythmias in the Emergency Department

A 31-year-old woman presents to the ED with palpitations. The ECG shows a regular, narrow complex tachycardia with a rate of 170 beats/min. She has a history of AV nodal re-entry tachycardia. Her vital signs are reassuring, with a blood pressure of 127/81 mm Hg. Adenosine has successfully converted her dysrhythmia in the past, but she asks whether there is an alternative treatment, because she hates the way it makes her feel. 

Case Conclusion

The 31-year-old woman with palpitations was crying while talking to her husband about how she was dreading that ?awful adenosine.? You reassured her and said, ?Don?t worry, there are some other things we can try.? You performed the vagal maneuver with postural modification as described in the recent REVERT trial, but unfortunately, it was not successful. Afterwards, you explained how you wanted to attempt using a CCB. The patient consented, and you ordered diltiazem 0.25 mg/kg IV over 2 minutes, with close monitoring for hypotension. The intervention was successful, and the patient was ultimately discharged.

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Comments »

1. Mohammed - August 3, 2020

Start ABC with the pt and try carotid massage
valsalva maneuver
If no benefit
Try verapamil 5mg in 100 cc N/S

2. edgar billowitz - August 3, 2020

Carotid sinus pressure (Carotid sinus message) CSP CSM I’ve had over 75% success with this technique over the years. (No adverse consequences eg the feared CVA. Simple valsalva maneuvers also work. Ice water NEVER works.

3. Todd Smith - August 3, 2020

CCB OR BB vagal cardioversion

4. Diana - August 3, 2020

verapamil

5. Stephanie Reynolds - August 4, 2020

Vagaries maneuvers

All comments are held for approval.