SVT: Unable to obtain IV...IO?

If patient is stable with SVT I would probably not go with IO if transport time is short. If VTACH, than yeah I would go IO to treat that.

You pose a good question though regarding IO adenosine. Thanks for the link!
 
Good question, I have never had the situation arise
 
Whew. It took me 3 days to get the courage to post this. All I could think is I'm going to get flamed and get asked "and you're a Paramedic?!?!" :lol:

IV's make me nervous as a new medic. Why? Because in the back of my head I think...if I can't get an IV on this terrible call and for some reason, IO won't happen...
 
Hockey said:
Whew. It took me 3 days to get the courage to post this. All I could think is I'm going to get flamed and get asked "and you're a Paramedic?!?!" :lol:

IV's make me nervous as a new medic. Why? Because in the back of my head I think...if I can't get an IV on this terrible call and for some reason, IO won't happen...
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No Vagal, No IV, No IO. Cardiovert
 
If i had an SVT and couldn't get an IV, assuming they are hemodynamically stable just txp...

If the patient truly is having severe symptoms or is unconscious than the definitive care is the same, cardioversion. (except for possible long standing a-fib >48 hours)

If the patient isn't conscious, thats why we have things like versed or ativan which we can give IM or IN to sedate them for cardioversion.

Adenosine doesn't work on many patients. Sometimes you will end up sedating and cardioverting regardless if the situation calls for immediate care.

Also, IO adenosine may pose the problem of losing the potency of the drug by the time it reaches the myocardium. You should be performing an immediate flush of 20ccs on a regular IV to get it into circulation asap. If it comes all the way from the lower extremities and isn't direct into a vein it may not work?
 
The half-life of adenosine is 10 seconds and is cleared from the plasma in under 30 seconds. With that being said I would highly doubt you would see effects dramatic enough to convert someone with legit svt even with a large fast flush. Stable svt I would monitor, unstable sedate as stated and cardiovert.
 
IO adenosine should work, especially in a humeral head IO. Watch some videos on how fast IO contrast dye is absorbed into the system, there really isn't a delay.
 
NYMedic828 said:
Also, IO adenosine may pose the problem of losing the potency of the drug by the time it reaches the myocardium. You should be performing an immediate flush of 20ccs on a regular IV to get it into circulation asap. If it comes all the way from the lower extremities and isn't direct into a vein it may not work?
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Granted the research used Pigs and not humans, but they found that the dose required was less than with a peripheral IV, which would support the theory that it should work better than an IV.

Either way, if you cannot gain access then Versed and cardioversion is the answer.
 
I've got an IO question but probably not worthy of its own post, so I'll just tag along here. Are there drugs that can be pushed by IV but not by IO?
 
Simusid said:
I've got an IO question but probably not worthy of its own post, so I'll just tag along here. Are there drugs that can be pushed by IV but not by IO?
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I can't see why there would be but I don't know for sure.

The osseous tissue is extremely rich in blood supply and circulation the only thing I have come to notice in my short time as a medic is that it is much harder to push drugs into, and you cannot gravity drip meds into it. You need some form of pressure behind the bag.

I imagine it has to do with the fact that you are kind of pushing through a network of spongy material with less elasticity than that of a vein, which would just be an open pipe with a more constant flow of blood in it. Pushing d50 through an IO is a chore.

The only thing questionable for me with adenosine IO is that in NYC I can only do a tibial IO, which puts the entrance site for the meds twice as far from the myocardium it needs to act on.
 
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Alright. Initial article was re: pediatrics. I've seen tibial IO adenosine work in infants.

Now, many of us are using IO's as a second-line vascular access option for ALL patients. I've been told that a humeral head IO has acceptable time to central circulation to be used with adenosine - and I know at least one "supermedic" who's done it successfully.
 
Simusid said:
I've got an IO question but probably not worthy of its own post, so I'll just tag along here. Are there drugs that can be pushed by IV but not by IO?
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All of our drugs carried by ALS can be infused via IO. Big exceptions I know of are only in the hospital setting. Chemotherapy is the big one that comes to mind. I'll see if I can find a reference for this. If anyone knows better please correct me.

D50 is a PIA but it can be done.
 
If the Pt is stable SVT and you have tried the Vagel manuvers, and you are thinking of Cardioversion then you need some kinda of access. In our service you can't do any type of invasive procedure without IV access. If Pt is stable enough transport without IV. Have O2, and monitor (12-lead obtained for sure). If Unstable then really do you have a Choice? EZ-IO is awesome and pretty easy to access.
 
Ramis46 said:
If the Pt is stable SVT and you have tried the Vagel manuvers, and you are thinking of Cardioversion then you need some kinda of access.
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If they're stable, why would you be thinking of cardioversion? Just transport. If they're unstable, sure drill them but they're getting cardioversion with access or not. If you have it available and it's tolerable, midazolam IN or diazepam IM would likely be appreciated by the patient as well.
 
I've cardioverted into asystole before, so I'd like to have some sort of access before I start electrical therapy.

I've chemically converted several people on the first round of 12 after having them tell me that the adenosine didn't work. With a Hx of known failuire to chemically cardiovert, I'll go with a 16G instead of an 18G, and do the standard 20cc rapid flush. I'm also not opposed to getting an EJ for the SVT pt; I've done it quite a few times on the CHF/APE.

If nothing else, I'd do the IO prior to cardioversion. The painful part is not the drilling, it's the infusion afterwards, so don't forget to admin lido at the site if they're conscious. You'll need access for arrest meds if you kill them by cardioversion. I would have the tube kit out, and the arrest meds at the ready before I cardiovert, just in case.
 
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