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Now let’s cover Adenosine. Adenosine is effective in terminating narrow complex SVT due to reentry involving AV or Sinus node. It’s used for unstable narrow-complex reentry tachycardia and it should be given while preparing to cardiovert. It’s important to note that Adenosine does not convert atrial fibrillation, atrial flutter or ventricular Tachycardia known as V-tach. Adenosine is indicated for: narrow-complex supraventricular tachycardia or SVT, unstable narrow-complex reentry tachycardia, regular and monomorphic wide-complex tachycardia, or as a diagnostic maneuver for stable narrow-complex SVT. Adenosine is contraindicated in poison/drug induced tachycardia or second or third-degree heart blocks. Now it is safe during pregnancy. It is less effective in patients taking theophylline or caffeine and if administered for irregular polymorphic wide-complex tachycardia or VTach, it could cause deterioration including hypotension. Its side effects include transient periods of flushing, chest pain or tightness, brief periods of asystole or bradycardia, and ventricular ectopy. Reduce the initial dose to 3 mg in patients receiving dipyridamole or carbamazepine, in heart transplant patients or if given by central venous access, remember that transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVT. This medication should be delivered IV, Rapid Push. First, place the patient in a moderate reverse Trendelenburg position before administration of the drug. The initial bolus of 6mg is given rapidly over 1 to 3 seconds followed by a normal saline bolus of 20ml. It’s recommended that the extremity in which the drug was administered be elevated. A second dose of 12mg can be given in 1 to 2 minutes if needed. Now, while we’re doing this, make sure to record a rhythm strip during administration. Draw up the adenosine dose and saline flush in 2 separate syringes. Attach both syringes to the IV injection port closest to the patient. Clamp the IV tubing above the injection port, then Push IV adenosine as quickly as possible. While maintaining pressure on adenosine plunger, push the normal saline flush as rapidly as possible after the adenosine. Unclamp IV tubing and monitor the outcome.
In this lesson, we'll go over the medication adenosine and all of its effects, including indications, precautions and contraindications, and adult dosages. At the end of the lesson, we'll provide you with a Word about defibrillation.
Adenosine is effective at terminating narrow complex SVT due to a reentry involving the AV or sinus node. It's used for unstable narrow complex reentry tachycardia and should be given to the patient while also preparing to cardiovert.
Pro Tip #1: It's important to note that adenosine does not convert atrial fibrillation, atrial flutter, or ventricular tachycardia.
Indications for adenosine include:
There are some adenosine precautions and contraindications to be aware of, including:
Adenosine is safe to administer to pregnant patients.
Pro Tip #2: Adenosine is less effective in patients who are taking theophylline or caffeine. And if administered for irregular polymorphic wide complex tachycardia or V-tach, it could cause a deterioration including hypotension.
Adenosine side effects include:
Pro Tip #3: Reduce the initial dose of adenosine to 3mg in patients who are also receiving dipyridamole or carbamazepine, in heart transplant patients, or if adenosine is given by central venous access.
Remember, transient periods of sinus bradycardia and ventricular ectopy are common after termination of SVT.
Adenosine should be delivered via rapid IV push and follow the steps below when administering the drug.
1. First, place the patient in a moderate reverse Trendelenburg position before administering the drug. It is highly recommended that whatever extremity in which adenosine is administered is elevated.2. Rapidly administer the initial bolus of 6 mg over 1 to 3 seconds.3. Follow the adenosine with a normal saline bolus of 20 ml. A 2nd dose of 12 mg of adenosine can be given after 1 to 2 minutes if needed.4. While administering the medication, make sure to record the rhythm strip.
Pro Tip #4: Draw up the adenosine dose and saline flush in two separate syringes. Attach both syringes to the IV injection port that's closest to the patient. Clamp the IV tubing above the injection port. Push the IV adenosine as quickly as possible. While maintaining pressure on the adenosine plunger, push the normal saline flush as quickly as possible after the adenosine.
5. Unclamp the IV tubing.6. Monitor the outcome.
Defibrillation does not restart the heart. Defibrillation only stuns the heart and briefly terminates all electrical activity, including V-Fib and pulseless V-tach. If the heart is still viable, its normal pacemakers can eventually resume electrical activity, such as a return of spontaneous rhythm, that ultimately results in a perfusing rhythm.
In the first minutes after successful defibrillation, however, any spontaneous rhythm is typically slow and may not create pulses or adequate perfusion. The patient needs CPR, beginning with chest compressions, for several minutes until sufficient heart function resumes.
Also, not all shocks will lead to successful defibrillation. Which is why it's important to resume high-quality CPR immediately after a shock, beginning with chest compressions.
To ensure safety during defibrillation, always announce the shock warning. State the warning firmly and in a forceful voice before delivering each shock. This entire shock warning sequence should take less than 5 seconds:
When pressing the shock button, the operator of the defibrillator should be facing the patient, not the machine. This helps to ensure coordination with the chest compressor and to verify that no one accidentally resumed contact with the patient.
You don't necessarily need to say, clear (as you could choose another word), but you must warn other members of the team that you are about to deliver a shock and that everyone must stand clear of the patient. Though, uniformity isn't a bad thing, and if all are expecting to hear, clear, that might still be the best option.