- Regular narrow-complex tachyarrhythmia
Which of the following treatments would NOT be indicated as first-line treatment in the presence of a regular narrow-complex tachycardia?
No, that is not quite right.
Atropine is indicated for bradycardia, not tachycardia, and adenosine should be used only after vagal manoeuvres have failed to terminate the narrow-complex tachycardia. Synchronised cardioversion is used in patients with adverse features due to tachyarrhythmia but vagal manoeuvres can be used as first-line treatment whilst arrangements for cardioversion are made, or in patients in whom vagal manoeuvres and drug therapy have been ineffective.
If the patient is pulseless and unresponsive this is PEA and immediate CPR is required. In a stable patient vagal manoeuvres such as Valsalva manoeuvre or carotid sinus massage will terminate up to a quarter of episodes of paroxysmal SVT.
No, that is not quite right.
Atropine is indicated for bradycardia, not tachycardia, and adenosine should be used only after vagal manoeuvres have failed to terminate the narrow-complex tachycardia. Synchronised cardioversion is used in patients with adverse features due to tachyarrhythmia but vagal manoeuvres can be used as first-line treatment whilst arrangements for cardioversion are made, or in patients in whom vagal manoeuvres and drug therapy have been ineffective.
If the patient is pulseless and unresponsive this is PEA and immediate CPR is required. In a stable patient vagal manoeuvres such as Valsalva manoeuvre or carotid sinus massage will terminate up to a quarter of episodes of paroxysmal SVT.
No, that is not right.
Atropine is indicated for bradycardia, not tachycardia, and adenosine should be used only after vagal manoeuvres have failed to terminate the narrow-complex tachycardia. Synchronised cardioversion is used in patients with adverse features due to tachyarrhythmia but vagal manoeuvres can be used as first-line treatment whilst arrangements for cardioversion are made, or in patients in whom vagal manoeuvres and drug therapy have been ineffective.
If the patient is pulseless and unresponsive this is PEA and immediate CPR is required. In a stable patient vagal manoeuvres such as Valsalva manoeuvre or carotid sinus massage will terminate up to a quarter of episodes of paroxysmal SVT.
No, that is not right.
Atropine is indicated for bradycardia, not tachycardia, and adenosine should be used only after vagal manoeuvres have failed to terminate the narrow-complex tachycardia. Synchronised cardioversion is used in patients with adverse features due to tachyarrhythmia but vagal manoeuvres can be used as first-line treatment whilst arrangements for cardioversion are made, or in patients in whom vagal manoeuvres and drug therapy have been ineffective.
If the patient is pulseless and unresponsive this is PEA and immediate CPR is required. In a stable patient vagal manoeuvres such as Valsalva manoeuvre or carotid sinus massage will terminate up to a quarter of episodes of paroxysmal SVT.
Yes, that is right.
Atropine is indicated for bradycardia, not tachycardia, and adenosine should be used only after vagal manoeuvres have failed to terminate the narrow-complex tachycardia. Synchronised cardioversion is used in patients with adverse features due to tachyarrhythmia but vagal manoeuvres can be used as first-line treatment whilst arrangements for cardioversion are made, or in patients in whom vagal manoeuvres and drug therapy have been ineffective.
If the patient is pulseless and unresponsive this is PEA and immediate CPR is required. In a stable patient vagal manoeuvres such as Valsalva manoeuvre or carotid sinus massage will terminate up to a quarter of episodes of paroxysmal SVT.
References
See chapter 8 of the ALS manual for further explanation and examples of how to analyse cardiac rhythm from the ECG.
See chapter 11 of the ALS manual for further reading about the tachycardia algorithm.
Essentials: The 6-stage approach and the ABCDE approach
The 6-stage approach
1. Is there any electrical activity?
2. What is the ventricular (QRS) rate?
3. Is the QRS rhythm regular or irregular?
4. Is the QRS width normal (narrow) or broad?
Any cardiac rhythm can be described accurately and managed safely and effectively using the first four stages.
[hrule]
5. Is atrial activity present? (If so, what is it: Typical sinus P waves? Atrial fibrillation? Atrial flutter? Abnormal P waves?)
6. How is atrial activity related to ventricular activity? (e.g 1:1 conduction, 2:1 conduction, etc, or no relationship)
Algorithm: The tachycardia algorithm
The tachycardia algorithm is available in chapter 11 of the ALS manual.
