83yo male in SVT

[Epi-do]

We were dispatched for a patient with shortness of breath and show up to find an 83 yo male complaining of SOB and a racing/pounding feeling in his chest. He states the episode began aprox 10 minutes prior to calling, while he was bringing groceries into the house. He has had similar episodes in recent months, but states he never contacted his doctor about it because the episodes would resolve in just a couple minutes.

Initially, BP 104/62, pulse 192 and bounding, RR 20 w/ mild distress. Skin is pale, warm, dry. + dizziness w/ changes in position, - CP but says he feels funny, -N/V.

We gave him O2, 4 lpm via N/C. The cardiac monitor showed SVT at 220. I had him attempt Valsalva's maneuver with no effect. We moved him to the cot and got him out to the ambulance. I started an IV and did a 12-lead. I then had him attempt Valsalva's maneuver a second time. His SVT converted to sinus rhythm with occassional PVCs.

The patient's BP went up to 120's/70's, HR 80's, RR16 w/ no distress. His color improved and he was pink when we arrived at the hospital. SOB resolved and he no longer feels funny. A second 12-lead was unremarkable.

It was just a cool run for me - the first patient in SVT I have had since getting my medic. While I did have the adenosine ready just incase I needed it, it was the coolest thing to see Valsalva's maneuver work. Just wanted to share.

 

[8jimi8]

i've always heard tales of surprising people with an ice cold washcloth over the face from behind! (results in sudden gasp and valsalva's!)

Nice job!

 

[i5adam8]

i've always heard tales of surprising people with an ice cold washcloth over the face from behind! (results in sudden gasp and valsalva's!)

Nice job!

Didn't do that but,in a ER clinical had the doc tell me to put an ice pack on the Pt's face and had her blow through a small Coffee straw which converted rhythm from SVT at 210 to a controlled A-fib.So in a way it worked,it told us what the underlying problem was.

 

[jamiga]

Nice job! I've had the same experience, except it was in the ER, and he was 77. EMS crew that brought him in did nothing for him. Valsalvas knocked him right out of it. ER doc kept commenting about how he has never seen it work... but there it was! Not sure why the EMS crew didn't do it in the truck.

 

[maxwell]

Well, it's good that you didn't (have to) give Adenosine. Rates above 200 usually play by different rules. Usually when you have a HR > 200, you should stop thinking reentry tachycardias (like AVNRT..what adenosine is aimed at...) and think about a bypass tract (like what we see in WPW, LGL). Adenosine could make that HR faster (make the HR of 200 go to 220) by blocking the AV node, and allowing faster stimulation down the other pathway. I've seen it. Best drug to keep handy (not that most EMS agencies do anymore) is Procainamide. Great drug. Yeah yeah yeah I know all the old medics here will complain about the lowpertension, etc. But totally doable.

But yay for the vagal stimuli!

i've always heard tales of surprising people with an ice cold washcloth over the face from behind! (results in sudden gasp and valsalva's!)

Nice job!

What a bad idea. Don't do that.

 

[tydek07]

Hey, that is cool that it was resolved by the Valsalva's maneuver. B)

EDIT: I have only come across SVT twice while working as a medic; one needed immediate cardioversion, and the other ended up getting adenosine. Would be awesome to have a pt convert using the Valsalva maneuver.

 

[JeffDHMC]

Along the same line, and I do not intend to jack the thread, at what point do you all think you can manually count a HR? How fast is too fast? Personally, after mnay many years of practice, I can tell you that my number is 150ish. After that I am not sure I would trust anyone that told me they counted anything higher.

jeff

 

[8jimi8]

Well, it's good that you didn't (have to) give Adenosine. Rates above 200 usually play by different rules. Usually when you have a HR > 200, you should stop thinking reentry tachycardias (like AVNRT..what adenosine is aimed at...) and think about a bypass tract (like what we see in WPW, LGL). Adenosine could make that HR faster (make the HR of 200 go to 220) by blocking the AV node, and allowing faster stimulation down the other pathway. I've seen it. Best drug to keep handy (not that most EMS agencies do anymore) is Procainamide. Great drug. Yeah yeah yeah I know all the old medics here will complain about the lowpertension, etc. But totally doable.

But yay for the vagal stimuli!



What a bad idea. Don't do that.

i don't know where i implied that I ever would do that. it sounds pretty freaking silly to me.

 

[Airwaygoddess]

Happy to hear the patient had a postive outcome, now I hope he follows up with his doctor for a detailed work up and dx. Thumbs up for Epi-do!

 

[Street Doc]

like I always say
A poop a day keeps the Dr. away

 

[rmellish]

Along the same line, and I do not intend to jack the thread, at what point do you all think you can manually count a HR? How fast is too fast? Personally, after mnay many years of practice, I can tell you that my number is 150ish. After that I am not sure I would trust anyone that told me they counted anything higher.

jeff

Call me crazy, but whenever I decide to count a HR, I like to use a monitor.

Taking pulses is a different story of course. Hard to count above the 120s-150s.

 

[Amack]

like i always say
a poop a day keeps the dr. Away

:d:d:d:d yup!

 

[HotelCo]

Bit of an old thread, isn't it?

 

[jason152318]

Thats cool. It always is the first thing that you do for a pt with SVT, but seems to rarely work. Although I had a pt once that converted into a sinus rhythm from SVT while attempting an IV. When I poked him he flinched, which may have precipitated the conversion. But then the hospital released the guy later in the day and he had another episode of SVT and we ended up giving adenosine, which converted him to a sinus rhythm.