40 years old lady with no known medical illness presented with palpitation in which she describe it as her heart is jumping out from the chest. Otherwise, no shortness of breath, no typical chest pain, no altered in consciousness.
On examination, patient is conscious and alert.
vital signs are as follow, RR:20 b.p.m, PR: 160, afebrile, BP 115/79, GCS full.
First ECG shows narrow complex tachycardia with no
visible P wave. It is regular rhythm with rate about 150 b.p.m. There is also
present of right bundle branch block. Otherwise no acute ischemic changes.
A trial of carotid massage and valsalva maneuver
yields negative result. In the absence of contraindication for adenosine,
patient was decided for trial of IV adenosine.
Patient was managed in resuscitation bay with vital
sign and cardiac monitoring attached to her. A large bore IV canulla attached
to three way stopper was inserted at left ante cubital fossa. Patient was then counseled
regarding complication of adenosine in which she may feel tightness of the
chest, sense of heart stop beating, cardiac arrhythmia and asystole which
require resuscitation. Intubation set with advanced cardiac life support set
was prepared.
The three way catheter was connected to two syringe.
One syringe consist of IV adenosine 6 mg and
another is consist of IV normal saline 20 cc. Then IV adenosine was pushed,
followed by rapid bolus of IV normal saline 20cc with the hand was elevated
above the heart level.
Cardiac monitors shows broad complex arrhythmia
consist of multiple ectopic foci before it finally shows sinus rhythm.
She was then
admitted to CCU for close observation.
Case of SVT in children
Paediatric Emergency Osce [link]
Answer: [link]
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