18 year old female...

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trauma1534

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You have an 18 year old female patient walk into your station and was brought there by one of the vollys. She is complaining of the feeling of her chest jumping out of her body. She has a b/p of 98/60, resp 36, HR 250's. She was putting up her christmas tree when this started. She is having a PSVT attack and has had this happen a few times in the past and the ER didn't do anything for her. She has been this way for aprox 30 min. now. What is your plan of action?
 
Hx of PSVT & being 18 years old... I would try CSM, I have had success in young adults, converting them and never ever starting a line. If this does not work, then I would attempt other vagal manuevers, then adenocard..then cardioversion if adenocard failed...

R/r 911
 
ridryder 911 said:
Hx of PSVT & being 18 years old... I would try CSM, I have had success in young adults, converting them and never ever starting a line. If this does not work, then I would attempt other vagal manuevers, then adenocard..then cardioversion if adenocard failed...

R/r 911
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Vagals didn't work... nothing worked before starting a line. She weighted aprox. 90 lbs!!! Very small featured. Hard stick!!! Would you stay and play or load and go?
 
Adenocard 6mg if it does not work 12mg then 12mg. If no releif. then Cardiovert. After giving 5mg Valium.
 
Well I would stick around for a few if she is still alert, try IV access and adenocard, after I got a 12 lead to verify that its really SVT and not A Fib with RVR. They both can mimic each other, and adenocard doesnt fix AFib RVR, however cardizem would work. Verify the rhythm, and then give the apropriate drug, if no change then transport and cardiovert if needed.
 
I would re-verify there is no "substance abuse" that might be a precursor as well, just because she has a hx.. of PSVT does not exempt her. Give a fluid bolus while preparing for cardioversion.. then sedate and see if the sedation might have even lowered the rate, then cardiovert.

There is no reason to for rapid transport or to hurry. SVT is not an "life threatening" condition and should be able to be controlled in the field setting. Hurrying up, or even running with L & S does not save time and only increases anxiety in the patient, (which she definitely does not need).

Can't start the line.. I would some how. Give her some Versed nasally for sedation for cardioversion, if the cardioversion did not work, I would consider I/O her while she is still sedated, if I was not successful in peripheral IV.

R/r 911
 
Why would you I.O? You can't give adenosine thru it, why bother?
 
You can administer Adenocard through I/O as well as 90% of medications (except Mg+ it messes with the RBC in the bone marrow) and as well as packed RBC's.

The infusion absorption of I/O is actually as quick as regular IV, the problem lies that most I/O's have a poor tendency to allow "rapid" amount. Thus pressure bags and flushes would have be performed while using Adenocard. Your potential may be less dramatic and I would probably go for 12mg in lieu of 6mg (after discussing with Doc).

Good points though..

R/r 911
 
ridryder 911 said:
Hx of PSVT & being 18 years old... I would try CSM, I have had success in young adults, converting them and never ever starting a line. If this does not work, then I would attempt other vagal manuevers, then adenocard..then cardioversion if adenocard failed...

R/r 911
Click to expand...


Would have to agree 100% with this course of action.

To me the patient still falls into "stable" category. Her complaint was basically of palpitations. There was no mention of any signs/symptoms of anything that made her unstable at the time.

Also............ who called it PSVT? Who observed the "P". Otherwise it would be SVT right? There is no rush here.
 
I agree with the need for a good assessment, and a 12-lead if possible (remember, not everyone has made it into the 21st century).

The first question is wheather or not the patient is "stable" The question isn't just B/P, but also general appearance.

First.. try to get a line, and have someone else try.

If the patient is unstable and you can't get a line, perhaps you have the ability to try IO, perhaps not. Cardioversion would seem to be in order with sedation if you can give versed nasally, otherwise, the patient needs to "bite the bullet" and take it.

If the patient is stable, and you can't get a line I'd probably conult with command, but my gut reaction would be to just Press Hard... 3 Copies and run a diesel drip.

If the patient is borderline, I'd talk to command about IO's and other options and perhaps cardioversion.



trauma1534 said:
You have an 18 year old female patient walk into your station and was brought there by one of the vollys.
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IS it just me, or does it sound like there is a story behind this... is this the child of a volunteer, or a "friend"??? either way, this call could be more difficult because everyone wants to help.
 
well
Into the Amb. Vagal dont Help?
Follow SVT protocol

and we out of there
 
Also consider undiagnosed WPW!!!!!!!! But SVT alone is very seldom an emergency. Also if it was around C'ville. Consider drugs.
 
prizonmedik said:
Also consider undiagnosed WPW!!!!!!!! But SVT alone is very seldom an emergency. Also if it was around C'ville. Consider drugs.
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No, believe it or not, the tox screen was negative.
 
Ridryder911 said:
You can administer Adenocard through I/O as well as 90% of medications (except Mg+ it messes with the RBC in the bone marrow) and as well as packed RBC's.

The infusion absorption of I/O is actually as quick as regular IV, the problem lies that most I/O's have a poor tendency to allow "rapid" amount. Thus pressure bags and flushes would have be performed while using Adenocard. Your potential may be less dramatic and I would probably go for 12mg in lieu of 6mg (after discussing with Doc).

Good points though..

R/r 911
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You can give it, but what are the chances its going to reach the heart before its half life "expires"? 2-3 seconds isnt long enough if you're using the tib.
 
It is the life within the circulation, and as well I prefer humeral using EZ I/O in lieu of tibial sites. A good flush if one is possible.. as well as a bolus before any med's..

R/r 911
 
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