Question

A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at 220/min. The pt BP is 128/58. The PETCO2 is 38 mm Hg, and the puse Ox is 98%. There is a vascular access in the L arm, and the pt has not been given any vasoactive drugs. An ECG confirms supraventricular tachycardia with no evidence of ischemia or infarction. The HR has not responsed to vagal maneuvers. What is the next action?

A. Administer adenosine 6 mg IV push
B. Administer amiodarone 300 mg IV push
C. perform synchronized cardioversion at 50 J
D. perform synchronized cardioversion at 200 J

Answer 1

For a patient in the ICU with stable SVT not responding to vagal maneuvers, administer adenosine 6 mg IV push as the next course of action. Cardioversion may be considered if pharmacological intervention fails and if the patient becomes hemodynamically unstable.

Step-by-step explanation:

The next action for a patient in the ICU with a confirmed supraventricular tachycardia (SVT) who is hemodynamically stable and has not responded to vagal maneuvers should be to administer adenosine 6 mg IV push. Adenosine temporarily slows the conduction through the AV node and can help terminate an SVT. If the first dose is not effective, a 12 mg dose can be considered.

Given the patient's stable blood pressure and the absence of acute ischemia or infarction, adenosine is preferred over immediate cardioversion. Cardioversion is generally reserved for patients who are hemodynamically unstable or when pharmacologic treatment is ineffective.