Emergency management of SVT (Would you choose adenosine?!)

[@NinjaSheepa]

Thank you! Very interesting. One element I'd also consider is that you miss out on the diagnostic element of the adenosine because there is always that question whether it's not really an atrial flutter.

[@First10EM]

Luckily, calcium channel blockers will also slow the heart enough to make a diagnosis in atrial flutter, and are one of the treatment options for atrial flutter. Adenosine might (and I mean might) help you make a diagnosis, but isn't therapeutic in the least. So CCBs still a better choice

[@SamWatsonTV]

Great teaching. Thank you.

[@First10EM]

Thanks for watching

[@ICUBIA]

Hello I,m an Spanish emergency doctor. Thank you for your great work, i´m so impress. I´d like to know how do you do this videos. I refer to the process, edition, programs that you use, win/mac. Thank you again.

[@First10EM]

So far, I have kept it very simple, with as little editing as possible It helps that I had a spare camera sitting around, but phone video probably adequate.. sound more important, with a good microphone I have been using CapCut on widows, as I found it the easiest video editing software to learn. When I started it was free, but they have been making more and more important features only available in a pro version (which I now pay for), there might be better options available Probably the best approach is to plan ahead, like you might a conference talk, so there are as few edits as possible (I do most of my videos in a single take with very few cuts, so the only edits are to add pictures / text / stock video if I want)

[@lofiwine1458]

We don't have easy access to IV CCBs in Australia. Any utility with oral agents?

[@First10EM]

It's an interesting question. We've covered intranasal CCBs on the BroomeDocs podcast in the past, and my guess is oral could work, but I think the more appropriate (but still not evidence based) replacement would be IV beta blockers

[@mohelu86]

I understand the “horrible” feeling argument but for me, a prior explanation has worked very well. Having to use procedural sedation for 5 seconds “horrible” feeling is a bit much. However, risk of hypotension and the possibility of cardiomyopathy is too much risk to take.

[@First10EM]

Do you not sedate for electrical cardioversion?? Because that is much shorter lived. As far as the risk of cardiomyopathy, it is essentially 0, given no bad outcomes in any of the trials we have, and so calling it "too much" seems incorrect.

[@mohelu86]

@@First10EM my experience with adenosine is not necessarily pain but that feeling of impending doom which IS horrible but with gentle gradual but straight to the point explanation I found patients tolerate adenosine very well. I have yet to encounter patient with SVT that bluntly declined Adenosine.

[@First10EM]

1) You haven't had patients that bluntly declined adenosine, but are they aware they have an option? 2) Although not every patient has a horrible experience with adenosine, many do, and it seems silly to debate over just how bad the experience is when we have an alternative that not only avoids that experience altogether, but is also more effective and less expensive At the end of the day, you are obviously free to practice as you want, as long as your patients are aware of the alternative and are given a fair informed consent discussion. I can't imagine any patient choosing a drug that is less effective, more expensive, and has more side effects, but the option is there.

[@mohelu86]

@@First10EM I was referring to patients with prior Hx of SVT and had adenosine for it. Silly? … hmmm, I thought that was the point of the video. I am not disagreeing with you by the way. As with anything in medicine, any approach has pros and cons. As you said, as long as the patient is informed, but also the clinician is comfortable offering an alternative option that may be appropriate considering the situation. Thank you for bringing this up.

[@First10EM]

@@mohelu86 Yeah.. might have misunderstood you there. As long as the patient is informed, and is involved in the decision, all is good. My concern is, like many choices in medicine, the decision is too often made with the patient completely in the dark.