Tachycardia Teaching

In this lesson, we're going to let you play the role of team leader during a cardiac emergency – stable and unstable tachycardia. From start to finish, you'll be in charge of assessing the patient and providing therapy and treatment recommendations.

In this scenario, you've been presented with a 35-year-old male patient who is conscious and alert. You begin by asking him how he feels. During your primary assessment, you find him to be responsive, his airway open, and his breathing is rapid.

He tells you that symptoms began while he was at work. It was a very stressful day and symptoms began about an hour before you saw him. His chief complaints are that his heart feels like it's racing, he's experiencing some dizziness, and also some weakness.

Your initial assessment recap:

• 35-year-old male
• Conscious and alert
• Symptoms began about one hour ago
• Heart is racing
• Feels dizzy
• Feels weak

Since the patient doesn't appear to have any life-threatening conditions, you direct a team member to get a good set of vitals. A member of your team a few minutes later tells you that the patient's vital signs are:

• Respiratory rate: 24
• Pulse rate: 188
• Blood pressure: 110/70
• Skin: cool and pale
• SPO2: 92 percent

Based on his O2 saturation, you decide to start oxygen immediately and you do so at 4 liters via nasal cannula. Your goal is to titrate oxygen to keep his O2 saturation level at 94 percent or higher.

After oxygen has been started, you then decide that you need to get an ECG reading. You ask a team member to do this and after an ECG has been attached and you look at the readout, you see a narrow complex supraventricular tachycardia (SVT).

Since the patient is stable, you direct a team member to first try vagal maneuvers. However, that didn't work, so you now opt for drug therapy and direct a team member to start an antecubital IV 18 gauge with normal saline at a TKO rate.

Now that you have the IV established, you decide to try administering adenosine at 6mg via rapid IV push. You remind the team member in charge of medications to flush the line with 20ml of saline after giving the adenosine, so the medication gets completely into the central circulatory system.

You begin to consider a second dose of adenosine at 12mg in 1 to 2 minutes if this first dose doesn't work and if the patient is still stable.

After that first dose of adenosine, you take a look at the monitor and see that the patient is still in SVT. You direct a team member to get a new set of vitals. The team member comes back with the following information:

• Respiratory rate: 18 and shallow
• Pulse rate: 174 and weak
• Blood pressure: 94/70
• Skin: cool and pale
• SPO2: 94 percent

As you begin to consider getting a 12 lead ECG attached to the patient, he suddenly goes unconscious. Now that you have an unstable patient, that possible second dose of adenosine is off the table, so you direct the defibrillator team to perform synchronized cardioversion.

The defibrillator pads are applied, and the defibrillator is set for a synchronized shock of 50 joules. A defibrillator team member announces, Clear, charging, shocking at 50 joules on 3 – 1,2,3, and delivers a shock to the patient.

You again look at the monitor to see if there are any changes in the patient's rhythm, and this time, you see a normal sinus rhythm at 80 beats per minute. The patient's rhythm has been successfully converted.

The patient begins to regain consciousness after a few seconds. As he is becoming more responsive, you direct a team member to get a new set of vitals, as you continue to monitor the patient for changes.