Case 4

Ethan Krauspe, Richa Sheth

Case 4

36F admitted for ETOH detox.

RRT activated on third day of admission.

Tachycardic, HR 180s, dizzy/lightheaded but responsive, pulsatile in all ext. 

Team interface prompt

The outreach nurse arrived before you and has already tried vagal maneuvers.

Start with:

“Can I get the 30-second story: what changed, what have you tried, and what are you worried about?”

Then state whether this is stable, unstable, or peri-arrest.

EKG

Next Step?

Peri-Adenosine EKG:

Vagal maneuvers tried, then adenosine given. What’s this rhythm?

Analysis:

Teaching Points

  • Adenosine is for stable, regular, monomorphic tachycardia when SVT or regular monomorphic WCT is possible. Do not give it for unstable, irregular, or polymorphic WCT.

  • If the rhythm is narrow and fast, decide whether it is causing instability or reflecting another problem.

Case summary

Label: Tachycardia during RRT with adenosine guardrails.

Key issue: adenosine is only for stable, regular, monomorphic tachycardia contexts; use bedside/outreach input to judge stability and next step.

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