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Supraventricular Tachydysrhythmias in the Emergency Department
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Supraventricular Tachydysrhythmias in the Emergency Department -
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Publication Date: August 2020 (Volume 22, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 8/01/2023.

Author

Delbert D. Clark, DO, FAAEM
Staff Physician, Emergency Medicine Department, Naval Hospital Camp Pendleton, Oceanside, CA
Morgan McGuire, MD
Staff Physician, Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA
Mary Jones, MD
Staff Physician, Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA
Heather Bruner, MD, FAAEM
Assistant Clinical Professor of Palliative Medicine, University of California San Diego, San Diego, CA
David Bruner, MD, FAAEM
Staff Physician, Department of Emergency Medicine, Scripps Mercy Hospital, San Diego, CA

Peer Reviewers

James E. Morris, MD, MPH
Program Director, Emergency Medicine Residency; Clinical Associate Professor, Department of Surgery, Division of Emergency Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
Jennifer White, MD
Clinical Associate Professor, Associate Medical Director, Assistant Program Director, Sidney Kimmel College of Medicine at Thomas Jefferson University Hospital, Philadelphia, PA

Abstract

Diagnosing and treating supraventricular tachycardias is routine in emergency medicine, and new strategies can improve efficiency and outcomes. This review provides an overview of supraventricular tachycardias, their pathophysiology, differential diagnosis, and electrocardiographic features. Clinical evidence guiding contemporary practice is determined largely by multiple observational studies, with few randomized controlled trials. Current prehospital and emergency department management strategies beyond the use of adenosine and calcium channel blockers are addressed. Diagnostic and therapeutic recommendations are provided, based on the best available evidence.

Excerpt From This Issue

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. You are considering this patient’s request when another patient’s ECG is handed to you.

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