Cite this post as:
Scott Weingart, MD FCCM. SVT: The New Hotnesses. EMCrit Blog. Published on December 14, 2015. Accessed on December 4th 2022. Available at [https://emcrit.org/emcrit/new-hotnesses-for-svt/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: December 14, 2015
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Great minds…
http://broomedocs.com/2015/12/clinical-case-123-svt-better/
Any thoughts on verapamil if REVERT fails Scott?
Casey
Not a big fan of verapamil, compared to real agents like diltiazem. Time for your country to get that drug and nicardipine. Is there a big calcium channel blocker cabal–seriously what’s the deal. Have started to go to CCBs rather than adenosine when it seems that near death may freak out my patient.
Pharmalag…. Slightly slower than knowledge translation ?
Maybe this can help:
Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation. 2009.
http://www.ncbi.nlm.nih.gov/pubmed/19261367
“The conversion rates for the calcium channel blockers (98%) were statistically higher than the adenosine group (86.5%), p=0.002, RR 1.13, 95% CI 1.04-1.23. The initial mean change in blood pressure post-conversion in the calcium channel blocker group was -13.0/-8.1 mmHg (verapamil) and -7.0/-9.4 mmHg (diltiazem) and 2.6/-1.7 mmHg for adenosine.”
Great post, Scott. Thanks!
Cheers,
HL
We use two port IV tubing and always have it going into the antecubital fossa. The adenosine syringe gets hooked up to the most proximal port and a large saline flush hooked up to the port distal to that. When it’s go time, the adenosine is pushed, followed by a quick flush of the saline. This way, there’s no switching of syringes or changing of stopcocks
why would you still do that after finding that adenosine has no diminished effect when mixed with the flush?
It’s just easier for us to grab a prefilled adenosine and saline syringe and fire them both in then it would be to reconstitute the adenosine into 20mL of saline. Thanks for posting the new vagal maneuver video!
Ok, I think I am not getting across the the technique. You don’t need to reconstitute anything. Take the prefilled syringe of adeonsine, attach a needle to it and inject it into the 20 ml syringe where you’ve pulled the plunger down to make some space.
Just like some poster’s above, I/we have never used the stop cock method in the field (EMS) in our local agency. We have used a “two syringe”, two port technique. In fact about the only time we routinely use stop cocks is on IO’s or drawing up ped meds. Distal port (closest to the patient) has the 10 ml syringe with the Adenosine, the next port has a 20 ml syringe with saline. Line above the 20 ml syringe is pinched manually. On a three count. (1) push adenocard (2) push 20 cc (3) unkink line and run wide open… Read more »
Hello!
1) Love your podcasts, blog, and the merger with pulmcrit blog
2) Is there a standard period of observation after administration and successful conversion to sinus rhythm after using adenosine for PSVT?
Thanks!