Supraventricular Tachycardia

1. Admit to:

2. Diagnosis: PSVT

3. Condition:

4. Vital Signs:
q1h. Call physician if BP >160/90, <90/60;apical pulse >130, <50; R >25, <10;
T >38.5°C
5. Activity: Bedrest with bedside commode.

6. Nursing:

7. Diet: Low fat, low cholesterol, no caffeine.
8. IV Fluids: D5W at TKO.

9. Special Medications:

Attempt vagal maneuvers (Valsalva maneuver) before drug therapy.
Cardioversion (if unstable or refractory to drug therapy):
1. NPO for 6h, digoxin level must be less than 2.4 and potassium and
magnesium must be normal.
2. Midazolam (Versed) 2-5 mg IV push.
3. If stable, cardiovert with synchronized 10-50 J, and increase by 50 J
increments if necessary. If unstable,start with 75-100 J, then increase
to 200 J and360 J.
Pharmacologic Therapy of Supraventricular Tachycardia:
-Adenosine (Adenocard) 6 mg rapid IV over 1-2 sec,followed by saline
flush, may repeat 12 mg IV after 2-3 min, up to max of 30 mg total OR
-Verapamil (Isoptin) 2.5-5 mg IV over 2-3min (may give calcium gluconate
1 gm IV over 3-6 min prior to verapamil); then 40-120 mg PO q8h
[40, 80, 120mg] or verapamil SR 120-240 mg PO qd [120, 180,240 mg] OR
-Esmolol hydrochloride (Brevibloc) 500 mcg/kg IV over 1 min, then
50 mcg/kg/min IV infusion titrated to HR of <80 (max of 300 mcg/kg/min) OR
-Diltiazem (Cardizem) 0.25 mg/kg IV over 2-5 minutes,followed by 5 mg/h
IV infusion. Titrate to max 15mg/h; then diltiazem-CD (Cardizem-CD)120-240
mg PO qd OR
-Metoprolol (Lopressor) 5 mg IVP q4-6h; then 50-100
mg PO bid, or metoprolol XL (Toprol-XL) 50-100 mg PO qd OR
-Digoxin (Lanoxin) 0.25 mg q4h as needed; up to 1.0-1.5 mg; then 0.125-0.25 mg PO qd.

10. Symptomatic Medications:

-Lorazepam (Ativan) 1-2 mg PO tid prn anxiety.
11. Extras: Portable CXR, ECG; repeat if chest pain.Cardiology consult.
12. Labs: CBC, SMA 7&12, Mg, thyroid panel. UA.