In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage acute dysrhythmias but, in particular, supraventricular tachycardia.
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In today’s session, we’re going to talk about managing acute dysrhythmias but, in particular, supraventricular tachycardia. Now, this micro lecture really is ideally situated in Workshop Two but it’s really using the Australian Resuscitation Council Guideline 19 and anybody can access it any time. Instead of us going through the entire guideline, which we won’t have the time to do, you can do that in your own time once you’ve accessed it.
Let’s scroll all the way to the bottom to have a look at the flowchart. Here we have the flowchart. Now, I’m going to try and rotate this round, here we go, there we go. Now, let’s start by reminding ourselves what a supraventricular tachycardia is. Supra means above, ventricular means the ventricles, and it’s a tachycardia so this is a tachycardia, a fast rhythm that is originating above the ventricles. Once you’ve identified that, and you’ll learn this in your learning materials and at the workshops, this is how we manage it.
Step one then, arrive on the scene. Here is a case study for you guys. You’re called to a private address for an elderly female who’s complaining of feeling generally unwell and can’t quite describe what the situation is. Now, just be mindful as well that SVTs are not just experienced by the elderly but, in fact, we sometimes have people at the workshops, there are young people that come into the workshop with SVT so there are different causes from it.
The first thing you would do is treat your whole patient so do the airway breathing circulation as it says here, “Support ABCs,” that will always be the first thing you do in every patient. Give oxygen if there are signs of hypoxia. Monitor the ECG. At some point, you need to put on an ECG rhythm as well as take another set of vital signs. Now, in the previous lectures, we talked about the primary survey and secondary survey. Of course, the blood pressure in the SVO2 can be mostly done in the secondary survey but sometimes the things can experience you’ve got.
Then you recall your 12 lead ECG where you will identify your SVT. Identify and treat any reversible causes that you may see. For example and hypovolemia, you would always treat those things sooner rather than later because they’re in a primary survey. Now coming down here then, you’ll notice how it says, “Is the patient stable?” Now according to this guideline, the patient is not stable if they’ve got reduced levels of consciousness, they’ve got chest pain, they’ve got a systolic blood pressure below 90 or they’re demonstrating signs of heart failure.
If there’s any one of those, then they’re going down this side but we’re not going to talk about this side today, we’re going to move down here. If the patient hasn’t got any of these, then they’re classed as stable. Then you look at the QRS complex on the ECG, is it narrow? If it is, you come down here. If it’s not, if it’s broad you go down here and, again, we’re not going to talk about this part here. If it’s narrow and it’s regular, in other words, if the distance in between the two R-R intervals is regular, then you can use a vagal manoeuvre and that’s what we get into in this session.
A vagal manoeuvre that we tend to use in the workshop is getting yourself a large syringe, 50 ml, probably let a little bit of air out. Put your patient in a comfortable position maybe laying in a semi-recumbent position and get them to blow into it as hard as possible. I’ve had patients in the past who have blown into the syringe and I’ve seen the heart rate go from this, down to this, but then as soon as they stop breathing into it it’s gone back fast again. What you’re doing is you’re stimulating the 10th cranial nerve which is the vagal nerve.
Okay, so that’s a micro-lecture on supraventricular tachycardias.
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