Another SVT?
EMS called to a local Doctors office for a 71 year old male patient who came in for a routing check-up. During the exam the staff could not locate a radial pulse. They laid the patient supine and started a 20g IV running at W/O rate. On arrival EMS found patient was Conscious, alert and oriented to person, place, time and event. He had no complaint other then feeling a little light headed. He stated that he has been light headed off and on for the past year. Skin w/d PERRL and lungs clear equal bilateral. He denies any pain and says he has no shortness of breath with a SP02 of 88% room air.
IV was cut to KVO rate and pt was moved to EMS stretcher and secured in the back of the unit. 12 lead EKG was obtained and transmitted to the receiving ER.
BP 80/55
RR 16
HR 160-170
EKG diagnosed as SVT
After administering 12 mg of Adenosine the Ventricle rate slowed enough to show Atrial Flutter
12LEADEKG 
I know its technically SVT, however with the hypotension we have to determine if the HR is cariac related or another source. What is the pt normal HR? How much fluid was given before crew arrival? Why was 12mg Adenosine given as first round as opposed to 6mg? Being oriented x4 with only a little dizziness, I think it may be safe to withhold the medicine and rule out another source. What was the pt presenting condition after the Adenosine?
This is not SVT this was an Atrial Flutter case. There are leads showing “P” waves especially lead V1. There was 300cc of fluid given before the EMS crew arrived. Pt’s normal Heart Rate is Sinus Rhythm. 12 mg Adenosine was given due to there protocol standing orders of 12mg, 12mg, and 12mg for a total of 36mg. Their protocols for narrow complex tachycardia also uses Vagal manuever but it was unsuccessful They no longer use 6mg. The Atrial Flutter continued at 160-170bpm after the adenosine.
Ok gotcha, I understand much clearer now. Thanks for the clarification!
12, 12, 12?
So was that patient considered to be treated with Diltiazem after stabilizing his BP?
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