Adenosine for sinus tachycardia: Try to avoid this!

This is the feedback I gave the student on this case. (Recall that this was a young adult male who presented with dyspnea, chest pain, as well as pre-syncope, whose initial ECG showed a brisk tachycardia which went up to the 170s at points): At 150, about to speed up. Bottom line: “As you point out, this was sinus tachycardia. When you have sinus tachycardia, you have to look for causes and treat those. I encourage you to read David Baumrind’s excellent essay on this topic for a different explanation. Here’s mine. Sinus Tachycardia “Sinus tachycardia can be caused by hypovolemia, cardiogenic shock, hypoxia, thyroid storm, cocaine intoxication, alcohol withdrawal, or massive pulmonary embolism. Sinus tachycardia is not an arrhythmia, it’s a symptom. The patient is telling you – through their vital signs – that their body is being stressed by something. You have to figure out what this stress is, and treat that. You (the student) did all the right things to address the sinus tachycardia; getting a history and physical to suggest causes, performing a few tests to catch things the exam didn’t reveal, and trying a few interventions (like oxygen and fluids) that can act as therapy as well as being diagnostic.   The patient had a massive PE, as well as moderate thyrotoxicosis. There was little in the exam or ECG to suggest these, so transport to the ED with supportive care was about the best you could have shot for. The big thing to know about ...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research