ACLS review: SVT part 5

Note

For verapamil, give a 2.5 mg to 5 mg IV bolus over 2 minutes (over 3 minutes in older patients). If there is no therapeutic response and no drug-induced adverse event, repeated doses of 5 mg to 10 mg may be administered every 15 to 30 minutes to a total dose of 20 mg. An alternative dosing regimen is to give a 5 mg bolus every 15 minutes to a total dose of 30 mg

Beta blockers (class 1)

Esmolol: 0.5mg/kg bolus over 1 minutes followed by an infusion at 50mcg/kg/min for 4 minutes. If no response then repeat 0.5mg/kg bolus over 1 minute and increase maintenance infusion to 100mcg/kg/min. If inadequate response in 4 minutes, repeat 0.5mg/kg bolus over 1 minute and increase maintenance infusion to 150mcg/kg/min. If inadequate response in 4 minutes, continue repeating bolus dose and increasing maintenance infusion by 50mcg/kg/min until maximum infusion of 300mcg/kg/min has been reached.

Metoprolol: 5mg slow IV push over 5 minutes x 3 as needed to a total dose of 15mg over 15 minutes

Note

In principle these agents exert their effect by antagonizing sympathetic tone in nodal tissue, resulting in slowing of conduction. Like calcium channel blockers, they also have negative inotropic effects and further reduce cardiac output in patients with heart failure

Digoxin (IIb)

·         10-15mcg/kg

·         Usually 0.25mg IV q4h x 4 loading dose, then oral maintenance dose

·         Not useful in emergencies due to slow onset of action



Reviewed 2/28/16