A second attempt
You are working two up on a MICA unit with a qualified partner, and are sent single car to a 79 year old "Unconscious/Fainting: Not Alert." On arrival you find the patient conscious and alert, complaining of dizziness and palpitations. He has a referral from the local small ED to see a cardiologist for an episode of SVT for which he attended last week. You take this ECG which shows:
Supraventricular Tachycardia
Supraventricular Tachycardia with aberrancy
Atrial Flutter
Ventricular Tachycardia
Atrial fibrillation with Bundle Branch Block
The patient presents conscious and alert, with pale dry skin, a weak radial pulse, and a BP of 80/60. He complains of chest pain, nausea, and palpitations. You elect to provide:
Modified Valsalva Manoeuvre
Adenosine 6mg IV
Adenosine 12mg IV
Normal Saline 250ml bolus
Synchronised Cardioversion 150j
Amiodarone 5mg/kg
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