Adenosine given to Sinus Tach?

[Vorenus]

One way to figure out if this is a sinus tach due to exercise versus SVT is to wait a few minutes. If this is sinus tach from the exercising then the heart rate should go down relatively quickly. If it is SVT then time will have no affect and he will be a constant 170. With SVT there is also very little variation in the rate, it will be 170. With a sinus tach there will be some variability to the rate.

Just to wait a few minutes would have been my route of treatment, too.

Assess, vitals, line, then start transport. Depending on how long a drive you expect to have to the ER, there might have been a call for medication or not, but Adenosine with a HR of 170 instantly after post-exercise wouldn`t have been my first thought.

[waulen2980]

One way to figure out if this is a sinus tach due to exercise versus SVT is to wait a few minutes. If this is sinus tach from the exercising then the heart rate should go down relatively quickly. If it is SVT then time will have no affect and he will be a constant 170. With SVT there is also very little variation in the rate, it will be 170. With a sinus tach there will be some variability to the rate.

True, but if he was in a panic and adrenaline was surging, his HR would probably remain elevated at or near whatever his post aerobic HR was. Not sure if you have ever personally experienced that feeling, but I can tell you both from personal experience and what I've seen so far, you take someone in full flight or fight mode and their HR is not going south until you administer a sedative or in this case; adenosine.

[Arctickat]

Bing Bing Bing Bing Whoooooot Whoooooot Whooooot!!!!!!!!!!!!!!!!!!!!!!

[ERDoc]

Bing Bing Bing Bing Whoooooot Whoooooot Whooooot!!!!!!!!!!!!!!!!!!!!!!

True, but if he was in a panic and adrenaline was surging, his HR would probably remain elevated at or near whatever his post aerobic HR was. Not sure if you have ever personally experienced that feeling, but I can tell you both from personal experience and what I've seen so far, you take someone in full flight or fight mode and their HR is not going south until you administer a sedative or in this case; adenosine.

Even if you...er...he had anxiety with your...er...his "adrenaline...surging," 170 is pretty high. Their heart rate may not go back to normal, but it is unlikely to stay at 170. I'm having a little trouble buying the fact that you are a medical student.

[Vorenus]

True, but if he was in a panic and adrenaline was surging, his HR would probably remain elevated at or near whatever his post aerobic HR was. Not sure if you have ever personally experienced that feeling, but I can tell you both from personal experience and what I've seen so far, you take someone in full flight or fight mode and their HR is not going south until you administer a sedative or in this case; adenosine.

What ERDoc said.

Especially seeing that he was jogging - which suggests that he`s trained (or not, but at least he`s trying to start training ).

A little bit OT: Most UK Ambulance Services demand a fitness test prior to employing. If I remember correctly, there you`d have to be back under a 100 HR after 2 minutes post-exercise (varying) to be deemed fit for service.

[waulen2980]

Thanks for all the responses! I have another case I want to ask a question about from last night. I'll post in next thread...

Edited July 5, 2012 by waulen2980

[paramedicmike]

It is a little curious that as a medical student you are asking your questions here. It would seem that as a med student you would have the resources available to you to discuss this type case with either your attending or your peers.

[Kiwiology]

It is a little curious that as a medical student you are asking your questions here. It would seem that as a med student you would have the resources available to you to discuss this type case with either your attending or your peers.

I also wondered this but didn't really figure anything of it, but since you bought it up, perhaps the OP was curious as to the use of adenosine by Paramedics specifically?

[mobey]

I really don't think there is enough information here to comment on the treatment.

The following questions should be answered first:

1) What was the time between the initial pulse count and the arrival of the ambulance?

2) Cardiac history (including murmur), or family history of tachycardias?

3) Treatment prior to adenosine? eg, oxygen, fluid bolus, vagal stimulation?

4) Pts normal actiity level? (If this is a fit patient whom runs daily, a tach at 170 seems inappropriate)

5) Any recent history of palpitations, or tachycardias at rest or after slight excersise?

6) Current drug/alcohol use?

7) Recent lung infection?

8) Any signs of dehydration?

I will agree with the aura this thread is giving off, anxiety does cause tachycardia. It must be noted that relief of that anxiety will not nesissarily relieve the tachycardia.

[ERDoc]

And he has completely avoid our concerns. Waulen, you probably do not have a law suit. If you really are interested in filing one against the medics, get your records and have them reviewed by a lawyer. Trying to get medicolegal advice from an anonymous internet forum is probably not the best way to go about it. You could check out these sites:

http://www.mdjunction.com/forums/medical-malpractice-discussions/general-support (be sure to check out the embalmed groin thread)

http://www.expertlaw.com/forums/forumdisplay.php?f=82

http://www.lawyercentral.com/forum/viewtopics.cfm?Forum=35

Maybe you can find out on those forums if you will get your lottery ticket.