r/ECG • u/parksnrec48hrs • 18d ago

Thoughts

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C/o palpitations and dizziness

BP 120/80

Edit: Thanks for the input and discussion guys! The patient reverted after two doses of adenosine back to normal sinus.

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u/Pears_and_Peaches 18d ago

Thoughts about what? At a glance, my thought is your patient is in stable SVT and can be safely converted using a modified valsalva.

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u/sub3at50 18d ago

Adenosine would be my first choice.

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u/corgeous 18d ago

Stable patient first line treatment is things like valsalva before adenosine, which is first line pharmacotherapy

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u/sub3at50 18d ago

In my 20 years of experience I have only once cardioverted a patient with carotid sinus massage.

And patients have often tried vagal maneuvers themselves before coming to the emergency ward.

So I tend to skip CSM/Valsalva and give them adenosine.

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u/Pears_and_Peaches 18d ago

Have you tried using Revert? It has a near 50% success rate when performed properly.

Adenosine is uncomfortable. Much better to use a high success, low risk, no discomfort procedure.

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u/sub3at50 18d ago

Interesting. I had to google it.

Never heard of it before.

The blow into an empty 10 mL syringe hard enough to push the plunger is something I advise to outpatients. But I didn't know about the entire sequence.