ACLS review: SVT part 4

Adenosine

·         6mg rapid IV over 2-3sec.

·         Repeat Adenosine at 12mg rapid IV over 2-3sec.

·         Reduce dosage in patients using Tegretol or dipyridamole

·         Relatively contraindicated in patient with asthma

Note

If the rhythm does not convert within 1 to 2 minutes, give a 12 mg rapid IV push using the method above. The initial dose may be reduced to 3 mg in patients taking dipyridamole or carbamazepine, those with transplanted hearts, or if given by central venous access. Side effects with adenosine are common but transient; flushing, dyspnea, and chest discomfort are the most frequently observed.  Adenosine should not be given to patients with asthma.

Adenosine

·         Adenosine should be considered for stable monomorphic, regular wide complex tachycardia

·         Adenosine should not be used for irregular wide complex tachycardia

Pause after Adenosine

Calcium channel blockers (class 1)

·         Diltiazem: 0.25mg/kg over 2 minutes.  If ineffective, in 15 minutes may repeat 0.35mg/kg over 2 minutes.  Followed by a maintenance infusion of 5-15mg/hr

·         Verapamil: 2.5-5.0mg slow IV push over 2 minutes. May repeat with 5-10mg in 15 to 30 minutes. Maximum dose 20mg

Note

These drugs act primarily on nodal tissue either to terminate the reentry PSVTs that depend on conduction through the AV node or to slow the ventricular response to other SVTs by blocking conduction through the AV node. The alternate mechanism of action and longer duration of these drugs may result in more sustained termination of PSVT or afford more sustained rate control of atrial arrhythmias

Reviewed 2/28/16