SVT

[canoehead, BSN, RN]

A ten day old infant came into the ER with SVT at 300bpm. Normal lady partsl delivery with appropriate growth, but he had also had SVT at 4 hours old. It was successfully treated with one dose of adenosine 0.2mg/kg, and a cardiology referral as an outpatient.

We used adenosine 0.2mg/kg and successfully converted him, he vomited immediately after the injection, which I thought was a pretty normal response. Breastfed well within five minutes.

A few hours later, the SVT recurred, and was treated successfully in the same fashion. This time, he became a bright magenta pink about 5 minutes afterwards, and was crying. BP 90/50. At about ten minutes after that he became precode ghost white, no cap refill, and BP65/30. We treated with 10mg/kg saline with good recovery within ten minutes. HR remained 120-180.

What the hell happened?

In particular I don't understand the color changes. Has anyone seen the same reaction? Is it a precode sign, or an adenosine effect?

[NotReady4PrimeTime, RN]

Adenosine has such a short half life I don't think that was it. I have to think about this... Adenosine has significant vasodilatory effects, and flushing is a recognized side effect, so that could explain the magenta colour. The crying could explain the BP. Then with the decrease in afterload caused by the initial vasodilation the subsequent slump responding to fluid bolus makes sense. Yes?

[canoehead, BSN, RN]

Thanks, that was my best guess, but what a roller coaster!

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi,

Maybe he had a reflexive vagal response? I am not totally sure, but I also wonder if something else is going on with the kiddo like a congenital heart defect that hasn't been found yet!

If you guys do not have a PICU did you send him out to a facility that does, and one that can rule out other issues?

Annie