ER Diaries : Managing First Arrhythmia

Hey people

The case was amazing. It must be a normal presentation for SVT but the first time I got to manage.

Around 60/F kco HTn on treatment came with complains of chest discomfort since morning associated with palpitations , blurring of vision , headache .

I thought MI first . Asked her to repeat the history and tried asking her chest pain hai Kya . She still insisted its chest discomfort . I asked the staff for BP and ECG . While I connected her to the monitor .

The heart rate was 210 ! Spo2 was 93. Ecg showed SVT pattern . BP was not recordable . Shifted her to priority area . Connected fluid ( later realised that it was unnecessary ). Sent the ecg to cardiologist . He came down. We were doing vagal manoeuvre and adenosine. He came n told to give 100 J synchronised shock

. ( tab yaad aaya ! Arey warning signs🤦‍♀️ shock directly) sedated gave shock. She said aah 😅. (sedation didnt act even after 2 min I guess ). ACLS guides you to sedate but doesn’t teach you to check for instant sedation. The only thing I had sedated was agitated patient for Ryles Tube / seizing baby.

Then the change in rhythm back to sinus ( THat was WOW! ) BP was back to 130/70.

Ecg also showed normal sinus rhythm like ocean after storm . No trace .

I saw sinus rhythm. She was shifted to ICU for monitoring.

That’s the beauty of ER . Instant results .

So far so much

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