Comments on: PSVT-Adenosine http://medicscribe.com/2009/12/psvt-adenosine/ Peter Canning's EMS Journal Thu, 10 May 2012 13:53:46 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: medicscribe http://medicscribe.com/2009/12/psvt-adenosine/comment-page-1/#comment-8218 medicscribe Sun, 27 Dec 2009 15:52:03 +0000 http://medicscribe.com/?p=3012#comment-8218 You can quote my post on your blog. I don't have a twitter account. Medic4Christ, thanks for the comments. We use to use 3-way extensions all the time, but we stopped carrying them. Now we just have locks (we are actually called extensions thought they are only about four inches) and bags. You can screw off the end of the lock and screw in the bag if you need to. For awhile we carried prepackaged adenosine, which required me to screw on a needle to the end of the adenosine so I could do my double syringe. I did finally find the ACLS reccomendation for the double syringes. It is in the appendix of the 2005 Guidelines pocket handbook. You can quote my post on your blog. I don’t have a twitter account.

Medic4Christ, thanks for the comments. We use to use 3-way extensions all the time, but we stopped carrying them. Now we just have locks (we are actually called extensions thought they are only about four inches) and bags. You can screw off the end of the lock and screw in the bag if you need to. For awhile we carried prepackaged adenosine, which required me to screw on a needle to the end of the adenosine so I could do my double syringe.

I did finally find the ACLS reccomendation for the double syringes. It is in the appendix of the 2005 Guidelines pocket handbook.

]]> By: Magestic0o http://medicscribe.com/2009/12/psvt-adenosine/comment-page-1/#comment-8216 Magestic0o Sun, 27 Dec 2009 00:48:26 +0000 http://medicscribe.com/?p=3012#comment-8216 I want to quote your post in my blog. It can? And you et an account on Twitter? I want to quote your post in my blog. It can?
And you et an account on Twitter?

]]> By: Medic4Christ http://medicscribe.com/2009/12/psvt-adenosine/comment-page-1/#comment-8212 Medic4Christ Fri, 25 Dec 2009 16:04:38 +0000 http://medicscribe.com/?p=3012#comment-8212 Forgot. Could also be a-fib with aberrancy. So need to slow the rate down enough to see if Cardizem is needed. Sometimes a-fib rate is so fast (with RVR), hard to tell. So if Adenosine doesn't work, then it's probably afib or flutter or could even be junctional tach. If irregular and wide, then Amiodarance 150 mg over 10 min. should be used. Forgot. Could also be a-fib with aberrancy. So need to slow the rate down enough to see if Cardizem is needed. Sometimes a-fib rate is so fast (with RVR), hard to tell. So if Adenosine doesn’t work, then it’s probably afib or flutter or could even be junctional tach. If irregular and wide, then Amiodarance 150 mg over 10 min. should be used.

]]> By: Medic4Christ http://medicscribe.com/2009/12/psvt-adenosine/comment-page-1/#comment-8211 Medic4Christ Fri, 25 Dec 2009 14:40:35 +0000 http://medicscribe.com/?p=3012#comment-8211 Very nice commments and discussion. I agree with medicscribe in the way adenosine is administered. I have done it from the NS bag hanging method and syringe flush, and the flush is much more effective and has a much higher successful conversion rate, especially with first 6 mg dose. It does not dilute the dose. It's like putting a rocket booster on the shuttle to overcome the force of gravity using acceleration. With the short half-life this is a must. I made the mistake the first time I used it of waiting too long to push the syringe bolus and it didn't convert with the first dose. I always have my second syringe ready but I've never used both like this. I like it and will try it. Another suggestion is: I always use a 8" extension on the end of my IV setup. That way you have a saline lock if you want it or can easily hook up your line. Many of our med's come with needleless and some with needles to this eliminates further complicates, as our extensions have both. Lastly, you should be treating your patient, not the monitor or one specific sign/symptom. Is the pt symtomatic or asymomatic and then base treatment on this. Some pt's may not present serious and this is where the term "atypical" presentation comes in. RATE, RHYTHM, BP! Least evasive treatment should be considered first, but situations vary. What is best for your patient is what is to be done!! "To do no Harm!" Very nice commments and discussion. I agree with medicscribe in the way adenosine is administered. I have done it from the NS bag hanging method and syringe flush, and the flush is much more effective and has a much higher successful conversion rate, especially with first 6 mg dose. It does not dilute the dose. It’s like putting a rocket booster on the shuttle to overcome the force of gravity using acceleration. With the short half-life this is a must. I made the mistake the first time I used it of waiting too long to push the syringe bolus and it didn’t convert with the first dose. I always have my second syringe ready but I’ve never used both like this. I like it and will try it. Another suggestion is: I always use a 8″ extension on the end of my IV setup. That way you have a saline lock if you want it or can easily hook up your line. Many of our med’s come with needleless and some with needles to this eliminates further complicates, as our extensions have both. Lastly, you should be treating your patient, not the monitor or one specific sign/symptom. Is the pt symtomatic or asymomatic and then base treatment on this. Some pt’s may not present serious and this is where the term “atypical” presentation comes in. RATE, RHYTHM, BP! Least evasive treatment should be considered first, but situations vary. What is best for your patient is what is to be done!! “To do no Harm!”

]]> By: medicscribe http://medicscribe.com/2009/12/psvt-adenosine/comment-page-1/#comment-8205 medicscribe Thu, 24 Dec 2009 14:45:36 +0000 http://medicscribe.com/?p=3012#comment-8205 I did some further checking this morning and came up with the following: 1. From the drug insert: Dosage and Administration For rapid bolus intravenous use only. Adenocard (adenosine injection) should be given as a rapid bolus by the peripheral intravenous route. To be certain the solution reaches the systemic circulation, it should be administered either directly into a vein or, if given into an IV line, it should be given as close to the patient as possible and followed by a rapid saline flush. 2. This is from the Merck Manual on-line: Administration: I.V. For rapid bolus I.V. use only; administer I.V. push over 1-2 seconds at a peripheral I.V. site as proximal as possible to trunk (not in lower arm, hand, lower leg, or foot); follow each bolus with a rapid normal saline flush (?5 mL). Use of 2 syringes (one with adenosine dose and the other with NS flush) connected to a T-connector or stopcock is recommended (ACLS, 2005). http://www.merck.com/mmpe/print/lexicomp/adenosine.html When I looked in my AHA and ACLS texts, I couln't find the specific mention of the two syringes. Here is what I did find. 3. AHA Adenosine. If reentry SVT does not respond to vagal maneuvers, give 6 mg of IV adenosine as a rapid IV push (Class I). Give adenosine rapidly over 1 to 3 seconds through a large (eg, antecubital) vein followed by a 20-mL saline flush and elevation of the arm. http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67 The specific note of an amount of the flush (I've read variously 5, 10 or 20 and the term "flush" suggests to me they are talking about using a syringe. The elevation of the arm is again something I have heard of but never practiced. I will try to remember to do it next time. I did some further checking this morning and came up with the following:

1. From the drug insert:

Dosage and Administration
For rapid bolus intravenous use only.
Adenocard (adenosine injection) should be given as a rapid bolus by the peripheral intravenous route. To be certain the solution reaches the systemic circulation, it should be administered either directly into a vein or, if given into an IV line, it should be given as close to the patient as possible and followed by a rapid saline flush.

2. This is from the Merck Manual on-line:

Administration: I.V.
For rapid bolus I.V. use only; administer I.V. push over 1-2 seconds at a peripheral I.V. site as proximal as possible to trunk (not in lower arm, hand, lower leg, or foot); follow each bolus with a rapid normal saline flush (?5 mL). Use of 2 syringes (one with adenosine dose and the other with NS flush) connected to a T-connector or stopcock is recommended (ACLS, 2005).
http://www.merck.com/mmpe/print/lexicomp/adenosine.html

When I looked in my AHA and ACLS texts, I couln’t find the specific mention of the two syringes. Here is what I did find.

3. AHA

Adenosine.
If reentry SVT does not respond to vagal maneuvers, give 6 mg of IV adenosine as a rapid IV push (Class I). Give adenosine rapidly over 1 to 3 seconds through a large (eg, antecubital) vein followed by a 20-mL saline flush and elevation of the arm.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67

The specific note of an amount of the flush (I’ve read variously 5, 10 or 20 and the term “flush” suggests to me they are talking about using a syringe. The elevation of the arm is again something I have heard of but never practiced. I will try to remember to do it next time.

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