ACLS review: SVT part 2

Evaluate Rhythm

·         Obtain 12 lead EKG

·         Determine if QRS complex is ≥0.12 second

·         Determine treatment options.

Note:  Stable patients may await expert consultation because treatment has the potential for harm

Narrow Complex Tachycardias

·         Atrial fibrillation

·         Atrial flutter

·         AV nodal reentry

·         Accessory pathway–mediated tachycardia

·         Atrial tachycardia (including automatic and reentry forms)

·         Multifocal atrial tachycardia (MAT)

·         Junctional tachycardia (rare in adults)

Note:  Irregular narrow-complex tachycardias are likely atrial fibrillation or MAT; occasionally atrial flutter is irregular

Wide Complex Tachycardias

·         Ventricular tachycardia (VT

·         SVT with aberrancy

·         Pre-excited tachycardias (Wolff-Parkinson-White [WPW] syndrome)

 

Note:  Because ACLS providers may be unable to distinguish between supraventricular and ventricular rhythms, they should be aware that most wide-complex (broad-complex) tachycardias are ventricular in origin.

Vagal maneuvers

·         Carotid sinus massage

·         Coughing

·         Valsalva maneuver

·         Stimulation of gag reflex

·         Digital rectal stimulation

Rationale

·         Depresses AV node and sinus node

·         Terminates AV nodal reenterant tachycardia

·         Clarifies rhythm

Valsalva Maneuver

·         Performed by the patient (patient must be conscious and cooperative)

·         Document the dysrhythmia before treating

·         Explain the procedure to the patient

·         Instruct the patient to inhale and hold their breath and:

·         Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds.


Reviewed 2/28/16