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<font size=3>While I am sure people on this list would not be guilty of
it,<br>
one should never look at an SVT at a rate < 200 as the cause for shock
or other symptoms except at the end of the list.<br>
I have seen a patient with Respiration rate of 40, HR of 140 and ketones
on his breath appreciable from 4 feet away be treated with verapamil for
his "SVT" and Valium for his "anxiety" , while his
blood sugar was an unmeasured 600. (More than once, unfortunately, in 26
years.)<br>
If there is a reason to think the patient is volume depleted, unless they
are in renal failure, 250cc of NS is much safer than diltiazem as a
trial. <br>
If the SVR is low, fix it with your drug of choice (or if in medical
situation, turn down/off the nitroglycerin :) ) <br>
Only after I am convinced that the cause is cardiac rhythm would I treat
that (and when I'm not in Egypt, that's what I do for a living, so I
guess I should be talking about overdrive pacing :) ). <br><br>
Now if you have a s/p CABG patient (not bleeding) with sudden AF/RVR at
180 (use adenosine to make the dx if needed) then you can use diltiazem
for rate control appropriately. <br><br>
Lorick<br><br>
<br><br>
<blockquote type=cite class=cite cite="">I have seen it work, but I have
seen alot that I wouldn't do myself. (and<br>
I'm not really clear on what the back-up plan was should that
fail)<br><br>
ACLS seems to agree that unstable SVT gets cardioverted. I wouldn't test
the<br>
"improve the pre-load" theory without exhausting your options,
but in my<br>
experience the theory is 1 for 1<br><br>
jed rn<br><br>
"Sure, *in theory...*Communism works *in theory...*" -Homer J.
Simpson<br>
--<br>
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