Medications & Cardioversion
The treatment of choice for symptomatic
patients with a stable blood pressure is IV administration of
adenosine. The advantage of this drug is that it is relatively
safe, has limited side effects, and has a half life of 5 to 10
- The initial dose is 0.1mg/kg (maximum dose
is 6 mg)
- Due to the extremely short half
life, it should be administered through the port
closest to the hub of the IV catheter, or
directly into the vein within 1 to 2 seconds and
immediately followed with a 2-3 ml. bolus of
- If there is no rhythm change within 1 to 2
minutes, a second dose should be administered at twice
the first dose (up to 12 mg. maximum single dose) and
immediately flushed through with a 2-3 ml. bolus of
- Close cardiac monitoring is essential as
new arrhythmias may occur such as PVCs, sinus
bradycardia, dropped beats, or asystole. These
arrhythmias are self limiting and usually resolve without
intervention when the adenosine becomes deactivated.
the monitor with us in the Emergency Room. Examine nurse's notes
as patient is treated for PSVT in the ER!
Intravenous propranolol and verapamil are
commonly used to terminate PSVT in adults, but are used with
greater caution in the pediatric patient. These
medications result in long-duration adrenergic and
calcium-channel blockade causing cardiovascular collapse,
profound bradycardia, and death in the younger child. IV
verapamil or propranolol can be used for the acute treatment of
- The child is over 1 year of age.
- Has no underlying cardiac
- The child is not in CHF.
- The child is not on beta-blockers.
For the patient who is hemodynamically
compromised, synchronized cardioversion is the treatment of
choice. Ideally, prior to cardioversion, patients should:
- be intubated
- ventilated with 100% oxygen
- have secure venous or intraosseous access
- be considered for conscious sedation
Obviously though, if the child is quickly
decompensating, cardioversion should not be delayed while the
above therapies are performed.
The initial dose for synchronized cardioversion
is 0.5 joules/kg. If PSVT persists the dose is doubled.
Long term medical treatment of most patients
with PSVT often includes digoxin (except in those children with
- If digoxin fails to control PSVT, a
beta-blocker such as propranolol may be prescribed.
- Calcium-channel blockers are often
ineffective for most patients, but may be tried in those
patients who fail to respond to other medications first.
information on digoxin administration to children, click here
When the nurse provides discharge education for
the patient and family, a careful review of the precipitating
factors of PSVT must occur.
- The direct relationship between the
avoidance of these factors and the decrease in the number
of PSVT episodes must be stressed to the family and
understood by them.
- Home management techniques should be
taught to all members of the family with appropriate
- Additional education for the family
members should be encouraged, e.g. CPR and First Aid
- Emergency numbers should be reviewed with
the parent as well as follow up appointments for the
If a second dose of
Adenosine is indicated, it is to be the same amount as the
TRUE or FALSE
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