Supraventricular tachycardia

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I'm prepping for simulation labs this week and thought of a question (that was not assigned for homework) just thinking through what I would do in treating a patient with supraventricular tachycardia and wanted to pick some real nurses brains. I don't think this is an answer I'll find in a textbook.

Say a pediatric patient presents with tachycardia, let's say like HR 220. The child is irritable, rapid breathing, sweating.

Okay, I have all the lists of ideas of things to include in the assessment and I also have ideas for nonpharmacological things to try for SVT.

So here's my questions, and this is where I struggle with prioritization. I will tell you my thoughts first (as I know you gals/guys don't like doing the work for us), but I'd really like some feedback.

What should I do first? Should I continue the assessment or try the ideas to lower heart rate (Vagal maneuvers, ice over nose and mouth, thermometer in rectum for infant)? And at what point do I call the physician?

I am thinking that I should try the ideas for lowering the heart rate first since it's so high instead of continuing the assessment, but then I don't know. How am I to call the doctor if I haven't assessed anything? Also, not sure at what point a call should be put out to the doctor? And which things would be most pressing to include in the phone call?

Also these are the ideas of what I have for important assessments. Am I missing anything?

Apical pulse (full minute) Blood pressure (and in all 4 extremities), urine output, peripheral pulses, temperature of extremities, skin color, capillary refill, level of consciousness, skin assessed for cyanosis, inspection of respiratory and circulatory effort (amount of work to breath), edema (periorbital edema could indicate fluid overload/CHF)

Ugh, figuring out what to actually do with real patients and in what order is so much harder than learning symptoms, nursing interventions, and medications.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

With real patients the actual scenario is always slightly different than in school.

We don't take the B/P in all 4 extremities. Rhythms in babies are slow, fast, and absent. Stable/unstable.

They all start with the ABC's. Airway breathing circulation

Is there a pulse? Are they present in all 4 extremities? Is baby breathing? What is the 02 sat? What is babies color? Are the febrile? Have they been sick? What history do they have? Full term? Complications? history Brief....has this happened before? Have they been ill. babies weight.

Are they Crying? A screaming baby can have an elevated heart rate and doesn't necessary need to be treated a an arrhythmia. Treat dehydration, calm baby lower temp. We check for cap refill. If greater than 3 secs the baby is compromised.

Call for help, place baby on monitor and 02...here is where it varies....

Stable: good pulses good cap refill.....you try vagal maneuvers. I have seen babies face immersed in ice water this activates the vagal reflex/drivers reflex physical maneuvers increase AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the vagus nerve. These manipulations are collectively referred to as vagal maneuvers. Holding the nose and exhaling against the obstruction has a similar effect. There are other vagal maneuvers including: holding one's breath for a few seconds, coughing, plunging the face into cold water... the diving reflex.

If this doesn't work establish IV and think about giving adenosine.

Unstable: call for help. This baby doesn't look good might be lethargic color pale poor cap refill. Place on monitor 02...prepare for immediate cardioversion.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Here is the PALS study guide....http://www.americanheartclasses.com/cpr/wp-content/uploads/2011/10/PALS_Study_Guide.pdf

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That was incredibly helpful! Your link was very helpful as well. I really had no clue how to assess stable vs unstable. Thank you so much!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You are welcome....sometime you just need to know where to look....;)

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Extremely helpful, thanks Esme12!

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Specializes in IR, Cardiac Tele,Burns, Peds Trauma & ER.

Just took PALS and was about to post this... good on ya

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