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I found a beautiful, shiny silver hair today, and I was happy.
No salt and pepper for this girl. Oh, no.
1. I’m looking forward to being back on my floor next week (after a very long week of residency classes).
2. I don’t handle people who live ungrateful lives very well.
3. Chocolate is something I could eat every day.
4. Warmth and sunlight are good for the soul.
5. D.C., here I come! 13 days….
6. I generally dislike tattoo(s).
7. And as for the weekend, tonight I’m looking forward to knitting along to The Wire, tomorrow my plans include laundry and going out with a friend, and Sunday I want to finally finish those damn sleeves! (It took me over two months just to start them.)
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Sinus Rhythm (SR)
Normal heart rate (60 – 100), normal rhythm (P wave before every QRS complex; all P waves look alike; all QRS complexes look alike; normal P-R, QRS, and QT intervals)
Sinus Tachycardia (ST)
Fast heart rate (100 – 150), normal rhythm
Seen normally with excitement or exercise
Supravenricular Tachycardia (SVT)
Faster heart rate (150 – 280), abnormal rhythm
When studying the strip, P waves may or may not be present. The rate is so high that the P waves are often hidden in the T waves. The QRS complexes are narrow, unlike the wide ugly QRS complexes found in ventricular tachycardia (a much worse rhythm).
Assess the patient to see if he/she is stable or unstable (symptomatic). Symptoms include: weakness, fatigue, shortness of breath, anxiety, and hypotension (blood pressure is down because of a decreased cardiac output – the chambers of the heart don’t have time to fill as usual). Palpitations are not a symptom because you can expect them with any kind of tachycardia.
SVT Management:
Make sure the patient is on oxygen, has IV access, and is hooked up to a monitor. Keep a crash cart nearby. Try valsalva maneuvers/vagal stimulation to lower the heart rate. (Tell the patient to bear down as if he/she needs to poop.) With the stable patient you’ll be treating the SVT first with adenosine. (With an unstable patient skip the adenosine and go straight to cardioversion unless the doctor says otherwise.)
Adenosine has a half-life of only 4-8 seconds, so you need to give it quickly in order for it to reach the heart and be effective. You’ll need an IV in the AC or higher (a central line is preferred). Have the drug and a bolus of 10-20 ccs of saline ready to give right after each other (you stick both needles into the port at the same time so that you can shoot the bolus in right after the drug). With adenosine there should be a brief period of asystole (very important to have the crash cart close by) before the heart resumes a normal rhythm. There are three dosages to follow of 6 mg, 12 mg, and 12 mg. If the drug doesn’t work by the third round, you move onto cardioversion.
Cardioversion is similar to defibrillating (shocking) the patient. The difference is that the joules delivered are lower (starting at 30 vs 200/360) and are synchronized with the patient’s own rhythm. When cardioverting a person, don’t forget to be a nice nurse and give them some Versed, Valium, Morphine, etc. beforehand. It’s not a fun experience.
Additional treatment may also include ablation therapy, a procedure done in cath lab. The small group of cells that are triggering the SVT are located and killed.
** New nurse’s understanding of SVT management after two days of an arrhythmia recognition class. Feel free to correct any misunderstandings.
