SVT

MDM:
Diagnosis: Supraventricular tachycardia, stable
Evaluated patient for stability and suspect H and stable given:
No respiratory distress.
No chest pain that is suspected to be ischemic.
Mentating well with no evidence of encephalopathy on exam.
Maintaining sufficient blood pressure.
  • Give instability, will elect for pharmacologic conversion of supraventricular tachycardia. Pads on pt in case of hemodynamic deterioration
    • Adenosine 6 mg IV push with flush afterwards administered.
    • Refractory to initial adenosine
    • Adenosine 12 mg IV flush with flush afterwards administered.
    • Normal heart rate.
    • Repeat EKG obtained.
    • On repeat EKG:
      • EKG: Normal Sinus Rhythm. No arrythmia (no PACs, no PVCs), no brugada wave, no prolonged QTc, no delta wave/no shortened PR, no episilon wave, no evidence of ischemia. Interpretation: No cardiogenic etiology for arrhythmia obvious on EKG.
Diagnostically:
     Will evaluate for underlying precipitance that may have caused arrhythmia as above.
          CBC to evaluate for significant anemia
          BMP and Magnesium and phosphorus to evaluate for electrolyte abnormalities.
          Chest x-ray
          Urinalysis
          Utox
     to evaluate for occult infections that were not elucidated on review of systems or examination.
     Evaluate for myocardial ischemia resulting from episode of arrhythmia.
          Troponin
Therapeutically:
Will administer rate control to prevent subsequent episode.
Cardiology consulted.

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