Narrow Complex Tachycardia or Atrial Fibrillation w/RVR - Adult Pearls

What medication history should be asked about in narrow complex tachycardia?

Aminophylline, diet pills, thyroid supplements, decongestants, or digoxin

What dietary history should be asked about in narrow complex tachycardia?

Caffeine, chocolate

What drug history should be asked about in narrow complex tachycardia?

Nicotine, cocaine

What past medical history is relevant to narrow complex tachycardia?

Any cardiac history, CVA/AMI with A-Fib

What symptom history regarding heart racing should be asked in narrow complex tachycardia?

History of palpitations/heart racing

What symptom history regarding fainting should be asked in narrow complex tachycardia?

Syncope/near syncope

What percentage of SVT may vagal maneuvers convert?

Up to 25%

How should adenosine be administered for narrow complex tachycardia?

Rapidly pushed into a proximal IV site followed by an immediate 20 mL normal saline bolus

What alternative technique can be used to give adenosine and saline together?

Add adenosine to a 20 mL syringe and give as one rapid bolus

What is the first-line rate control agent class for irregular tachycardias?

Calcium channel blockers

Is adenosine effective for atrial fibrillation or atrial flutter?

Not usually effective, yet not usually harmful, and may help identify the rhythm

What ECG finding is absent in atrial fibrillation?

P-waves

What conduction pattern is typical of atrial flutter with variable conduction?

Patterns of 2:1, 3:1, or 4:1

How many P-wave morphologies define MAT?

More than 3

What conditions is MAT associated with?

Significant pulmonary disease such as COPD, pulmonary hypertension, and theophylline use

How should MAT be conceptually approached for treatment?

Like sinus tach; treat the underlying cause

What rhythms is synchronized cardioversion recommended for in narrow complex tachycardia?

Unstable atrial fibrillation, atrial flutter, and monomorphic regular SVT

How is an unstable patient defined in narrow complex tachycardia?

Abnormal vital signs suggesting poor perfusion along with altered mental status

What adenosine dose adjustment applies to patients with a central line, heart transplant, or on carbamazepine/dipyridamole?

The dose can be cut in half, starting with 6 mg