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Saturday, October 18, 2008

SVT at 0200

We got toned out at 0100 for a person feeling ill on the side of the highway with SO (Sheriffs Officer) on scene. This usually means someone is starting to have chest pains because they don't want to go to jail. When we arrive on scene I'm greeted by the SO and a tall man in his forties. The man explains to me that he is in SVT at a rate of about 186. He states that he has a history of SVT and that this time it won't go away with any of the valsalva maneuvers that he has tried. He let me know that he almost always converts with 6mg of Adenosine and if he doesn't, 12mg has always worked. This was one of the easiest patient assessments ever! I hooked him up to the monitor just to confirm what he was telling me and then started a line on him. While I was doing this I had him try another valsalva maneuver which didn't work. I then pushed the 6 mg of Adenosine which didn't slow him down at all. After that his heart rate went up to about 210. When I pushed the 12mg of Adenosine I carefully watched the monitor. Adenosine can do some fun things to heart rhythms. This time my patient went from SVT to Ventricular Tachycardia, a life threateneing rhythm. Luckily he stayed in it for about two seconds (literally) and then converted to a sinus rhythm at about 120. He could tell that he converted to a better rhythm as well. About that time MBA showed up and we loaded him up. And the reason that he was with SO is that his wife was driving him to the hospital when they saw the deputy do they decided to stop and ask for help. I told them next time to just call 911. It's faster.
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