Paroxysmal supraventricular tachycardia: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Unstable | #Unstable | ||
##Synchronized cardioversion 0.5-1.0 J/kg | ##[[Synchronized cardioversion]] 0.5-1.0 J/kg | ||
#Stable | #Stable | ||
##Vagal maneuvers | ##[[Vagal maneuvers]] | ||
##Adenosine | ##[[Adenosine]] | ||
###6mg IVP; 12mg IVP (if initial dose failed) | ###6mg IVP; 12mg IVP (if initial dose failed) | ||
##Calcium-Channel Blockers | ##Calcium-Channel Blockers | ||
###Diltiazem 15–20mg IV over 2min | ###[[Diltiazem]] 15–20mg IV over 2min | ||
####May give 25mg IV if inadequate response after 15min | ####May give 25mg IV if inadequate response after 15min | ||
####If IV bolus worked start IV infusion at 5–20mg/hr | ####If IV bolus worked start IV infusion at 5–20mg/hr | ||
####Contraindications: Hypotension, CHF | ####Contraindications: Hypotension, CHF | ||
###Beta-Blockers | ###Beta-Blockers | ||
####Metoprolol 5mg IV q5min x 3; give 50mg PO if IVP effective | ####[[Metoprolol]] 5mg IV q5min x 3; give 50mg PO if IVP effective | ||
####Esmolol 500mcg/kg IV over 60sec | ####[[Esmolol]] 500mcg/kg IV over 60sec | ||
#####May give repeat bolus if inadequate response after 2-5min | #####May give repeat bolus if inadequate response after 2-5min | ||
#####If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min) | #####If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min) | ||
Revision as of 16:30, 25 October 2014
Diagnosis
| Sx | Sinus Tach | SVT |
| Hx | volume loss | sudden onset |
| PE | dehydated | CHF-like |
| *HR | <180 | >180 |
| Variability | Yes | No |
*In infants HR cuttoff = 220
DDX
- WPW
- Lown-Ganong-Levine Syndrome
- Mitral disease
- Digitalis toxicity
- Acute MI
- Pericarditis
- Hyperthyroidism
- Drugs (alcohol, tobacco, caffeine)
Treatment
- Unstable
- Synchronized cardioversion 0.5-1.0 J/kg
- Stable
- Vagal maneuvers
- Adenosine
- 6mg IVP; 12mg IVP (if initial dose failed)
- Calcium-Channel Blockers
- Diltiazem 15–20mg IV over 2min
- May give 25mg IV if inadequate response after 15min
- If IV bolus worked start IV infusion at 5–20mg/hr
- Contraindications: Hypotension, CHF
- Beta-Blockers
- Metoprolol 5mg IV q5min x 3; give 50mg PO if IVP effective
- Esmolol 500mcg/kg IV over 60sec
- May give repeat bolus if inadequate response after 2-5min
- If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min)
- Diltiazem 15–20mg IV over 2min
See Also
Source
- Rosen's
- UpToDate