I want to look at another adenosine issue today - can (or should) you give adenosine to a patient with a wide-complex tachycardia (WCT)?
Spoiler: The answer to this questions is...
Or, more specifically:
- Adenosine is relatively safe in regular, monomorphic WCT.
- However, it can convert certain types of VT.
Our paramedic was just "minding his own business" when he was called for a patient with palpitations. He was an older person, with no history of any cardiac problems, and was hemodynamically stable. His rhythm strip, however, looked like:
So it's VT, right?
... as well as a regular narrow-complex tachycardia.
|Tell me if you see P waves. I didn't.|
VT with episodes of PSVT?
The full 12-lead ECG looked wide and scarey:
Our intrepid medic decided that adenosine would be appropriate, and gave a slug, right as the patient was going through a spell of WCT.
At first it seemed to work ....
Wait, what the heck - the adenosine converted a VT? Or was it aberrant SVT? What should the next drug be? How much does the response to adenosine change our impression?
To be continued...
Tell me what you think, and I'll be back with the follow-up, as well as how lessons from this case should affect your assessment and treatment in the field.