Documenting the heart’s response to adenosine
Let’s look at some different cases where adenosine was used. Rather than give you all the details about the age, gender, chief complaint, and vital signs, I’m just going to show you the rhythm strips.
Right now I’m only concerned with how the heart behaves during the administration adenosine.
The PRINT button is your friend!
These strips were given to me by the same paramedic who did such a wonderful job in Part II. For some reason, with this patient, he didn’t bother obtaining a 12-lead ECG prior to giving the adenosine.
He did, however, remember to press the PRINT button prior to giving the drug.
The following five rhythm strips are continuous.
I pulled these strips from the archives of the LP12. The paramedic in charge of the call suddenly remembered to hit the PRINT button after he gave the adenosine.
Better late than never!
The paramedics in this case actually did capture 12-lead ECGs of the pre and post-adenosine heart rhythms. However, I’m only going to post the strips of the initial rhythm and the heart’s behavior during the administration of the drug.
I pulled this case from the archives of the LP12. The treating paramedic did not capture a 12-lead ECG. He also didn’t push the PRINT button until the several seconds after the administration of adenosine.
Take a look at these cases and ask yourself some questions.
How are they the same?
How are they different?
Assuming that the patient was symptomatic but hemodynamically stable, was adenosine indicated?
Does the behavior of the heart during the administration of adenosine give you any information as to the mechanism of the tachycardia?
Based on what you see, would you give adenosine again?
Would you switch to another drug?
Looking forward to hearing your comments.
If you have rhythm strips laying around that were taken during the administration of adenosine, please scan them and email them to me at firstname.lastname@example.org.
I’m also interesting in any and all rhythm strips of attempted transcutaneous pacing (TCP)!
Narrow complex tachycardias – Part III