Sinus Tachycardia ?

Providers arrive at the scene of a 5 year old male with chest palpitations. The patient is alert and appears anxious. He is mildly short of breath. Symptoms occured spontaneously and have been present for the last hour. The patient is experiencing associaed nausea. The patient denies LOC, diaphoresis, or recent illness.

BP: 90/palp
P:   200/min, rapid
R:  22 (hyperventilating)
Sp02: Poor waveform

12 Lead ECG

ECG Interpretation and Case Discussion

This patient is clearly experiencing some type of supraventricular tachycardia. Though the QRS complexes are narrow and occur at regular intervals, there is no evidence of an aberrantly (non sinus) conducted p-wave. A close examination of the precordial leads reveals an extra, retrograde "blip" in V1 and V2. Retrograde P's make the diagnosis of a junctional tachycardia more likely. This patient is symptomatic but relatively stable. Appropriate treatment options include:
1) Vagal maneuvers
2) Adenosine 0.1 mg/kg IVP, may repeat at 0.2 mg/kg
3) Synchronized cardioversion 0.5-1 joule/kg

This patient was treated successfully with a rapid administration of adenosine. After a period of observation in the ED that included repeat ECGs, serum electrolytes, and cardiac monitoring, the patient was discharged.

ECG Interpretation

Junctional (supraventricular tachycardia), rate of 200/minute

For rapid, regular, narrow complex rhythms, consider the following:

• Atrial flutter
• SVT
• Sinus tachycardia