A question about Adenosine

Specialties Emergency

Published

Just a quick question.

Does Adenosine always stop your heart? I had a friend who had SVT and a HR of 280 and took it and she said she remembered feeling like something was pulling out of her body, limb pain, but stayed conscious. Her pulse went down to 125 in 10 seconds. Then she got started on Cardizem.

Is that abnormal?

Thanks for reading.

Specializes in CCT.

The very first time I gave adenosine the patient "rewarded" me with a 15 second period of asystole/agonal appearing beats. Upon dropping the patient at the ED I had to go search for a clean pair of underoos...

Give it fast, follow it with a 20ml flush, and WARN your patients they're going to feel a little funny. I have known of some cardiologist that used 18mgs at once in patients that were refractory to 12mgs (never heard of a higher dose). Granted, it's not ACLS guideline, but that's why he's the guy signing the orders. If all medicine was protocol based we'd put our symptoms in a vending machine and it would spit out the appropriate med.

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Specializes in CEN, CPEN, RN-BC.
If all medicine was protocol based we'd put our symptoms in a vending machine and it would spit out the appropriate med.

That would be a glorious day

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Specializes in CCT.
That would be a glorious day

Except how fast would the machine run out of hydrocodone? :D

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Specializes in CEN, CPEN, RN-BC.
Except how fast would the machine run out of hydrocodone? :D

Haha, the machine would need a pneumatic tube attached straight from pharmacy to refill the constant supply shortage of vicodin, percocet, and xanax!

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I hope you gave it as 6mg + 12mg instead of 18mg all at once. If so, I've never heard of that.

I have given adenosine 18mg at once bam...a few times. Usually with the cardiologist at bedside, and he knows what the pt requires to convert. Its not common, but have done it.

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Just wondering...if the 6-12-12 is given, and the pt does not convert...what would that mean?? what next? DC?

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Specializes in Cath Lab/ ICU.

Depends. Are they stable or unstable?

Adenosine helps us see the underlying rhythm. If it's just plain ol ST, then we treat the cause. Afib then we may try some other way to convert (cardizem, etc)

Or, we could Try cardioversion if they become unstable. Also depends in how long they've been tachy, their hx, anticoagulation, etc, etc

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Specializes in Trauma/ED.
Just wondering...if the 6-12-12 is given, and the pt does not convert...what would that mean?? what next? DC?

sync-shock cardioversion with sedation or just consult a cardiologist and they may decide to come down and try something themselves (ie. 18mg), but usually we just use electricity and be done with it...

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Thats what I was thinking. I have given it twice, the first time it worked, after the first dose (6mg) but it returned in about 20min. At the time I was so nervous ( I'm a newbie) that I dont remember what her rhythm was when she converted. But after she converted the second time she was put on a amiodarone drip. Reading this thread made me wonder, if its not svt, would adenosine work? If it's afib w/ rvr, will it also respond to adenosine?

I had a pt the other day who had a hx of a fib w/ rvr. She came in with a rate in 160's, but basically asymptomatic. She was a little SOB, but also had copd and used 02 at home. She was not responding to 3 boluses of cardizem. Her BP dropped, but not her heart rate. She was switched to amiodarone, and admitted. Later it made me wonder why the cardizem did not work. She had been converted in the past with cardizem successfully. Maybe they were trying to treat the wrong rhythm?

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I think what they are referring to is the adenosine protocol for alot of hospitals. You give 6 mg first, if that doesnt convert (put the patient back into a sinus or atleast slow their rate ) then you would proceed with more adenosine.

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Specializes in Emergency Department.

Sounds like we have a few people that haven't taken their ACLS class. tsk tsk.

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Specializes in CEN, CPEN, RN-BC.
Thats what I was thinking. I have given it twice, the first time it worked, after the first dose (6mg) but it returned in about 20min. At the time I was so nervous ( I'm a newbie) that I dont remember what her rhythm was when she converted. But after she converted the second time she was put on a amiodarone drip. Reading this thread made me wonder, if its not svt, would adenosine work? If it's afib w/ rvr, will it also respond to adenosine?

I had a pt the other day who had a hx of a fib w/ rvr. She came in with a rate in 160's, but basically asymptomatic. She was a little SOB, but also had copd and used 02 at home. She was not responding to 3 boluses of cardizem. Her BP dropped, but not her heart rate. She was switched to amiodarone, and admitted. Later it made me wonder why the cardizem did not work. She had been converted in the past with cardizem successfully. Maybe they were trying to treat the wrong rhythm?

Never seen amiodarone given for a fib. Wonder why digoxin wasn't considered.

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