First step of Management of Hemodynamically Stable SVT? - USMLE Forums
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Old 02-10-2013
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EKG First step of Management of Hemodynamically Stable SVT?

Hi friends i need your help
UW in one of the Q explanation mentioned that in hemodynamically stable patient with SVT the first treatment is Adinosine which is treatment of choice, and Carotid message is option if Adinosine is not available.
And in other Q explanation mentioned that hemodynamically stable patient SVT should be treated with vagal maneuvers followed by adinosine
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Old 02-10-2013
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According to MTB 2

The best initial step is vagal maneuvers
Followed by adenosine
and then Beta Blockers.

Are you sure there was nothing in the stem of the question which made more sense to give adenosine first?
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Quote:
Originally Posted by Brainiac View Post
According to MTB 2

The best initial step is vagal maneuvers
Followed by adenosine
and then Beta Blockers.

Are you sure there was nothing in the stem of the question which made more sense to give adenosine first?
Plz check the explanation of Q.Id 4920 and Q.Id 4709
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Quote:
Originally Posted by heartbeat View Post
Plz check the explanation of Q.Id 4920 and Q.Id 4709
I think the key phrase is "patients should try the vagal maneuvers first" before adenosine is given.
So, in ER adenosine is the first line treatment since it is therapeutic as well as diagnostic.
While outside/when the adenosine is not available vagal maneuvers should be tried.
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Quote:
Originally Posted by Novobiocin View Post
I think the key phrase is "patients should try the vagal maneuvers first" before adenosine is given.
So, in ER adenosine is the first line treatment since it is therapeutic as well as diagnostic.
While outside/when the adenosine is not available vagal maneuvers should be tried.
Did you mean that if the patient presented to ER with SVT and Adinosine is available, should not try to do vagal maneuvers and going directly to give him/her Adinosine
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Quote:
Originally Posted by heartbeat View Post
Did you mean that if the patient presented to ER with SVT and Adinosine is available, should not try to do vagal maneuvers and going directly to give him/her Adinosine
I think vagal maneuvers is the answer if it is among the answer choices. But be careful in choosing carotid massage in an older patient with s/s suggestive of carotid artery disease. So, in these patients choose adenosine even if carotid massage is among the answer choices.
However, if valsalva, ice immersion of face and any other vagal maneuvers are among the choices they can be tried before adenosine BUT again look for specific contrindications in the question stem before choosing any of them.
If they ask for "best medication/pharmacological agent then the answer is obviously adenosine but if it is not among the answer choice choose one of the Ca channel blocker (Verapamil) or a beta blocker.
Hope this helps.
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