16 Supraventricular Tachycardia
BUY
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Beta-blockers:
-Carvedilol (Coreg) 3.125 mg PO bid, then slowly increase the dose every 2
weeks to max 25 mg PO bid if <85 kg or 50 mg PO bid if > 85 kg. [tab
3.125, 6.25, 12.5, 25 mg] OR
-Metoprolol (Lopressor) 6.25 mg PO bid, then 12.5-50 mg PO bid [50, 100
mg].
-Bisoprolol (Zebeta) 2.5-10 mg qd; max 20 mg qd [5,10 mg].
Digoxin: (Lanoxin) 0.125-0.5 mg PO or IV qd [0.125,0.25, 0.5 mg].
Inotropic Agents:
-Dopamine (Intropin) 3-15 mcg/kg/min IV (400 mg in 250 cc D5W, 1600
mcg/mL), titrate to CO >4, CI >2; systolic >90 OR
-Dobutamine (Dobutrex) 2.5-10 mcg/kg/min IV, max of 14 mcg/kg/min (500
mg in 250 mL D5W, 2 mcg/mL) AND/OR
-Milrinone (Primacor) 50 mcg/kg IV over 10 min, followed by 0.375-0.75
mcg/kg/min IV infusion (40 mg in 200 mL NS, 0.2 mg/mL);
arrhythmogenic; may cause hypotension
Potassium:
-KCL (Micro-K) 20-60 mEq PO qd.
10. Symptomatic Medications:
-Morphine sulfate 2-4 mg IV push prn dyspnea or anxiety.
-Heparin 5000 U SQ q12h.
-Docusate sodium 100-200 mg PO qhs.
-Ranitidine (Zantac)150 mg PO bid or 50 mg IV q8h.
11. Extras: CXR PA and LAT, ECG now and repeat if chest pain or palpitations.
12. Labs: SMA 7&12, CBC; cardiac enzymes: CPK-MB, troponin T STAT and
q6h for 24h. Repeat SMA 7 in AM. UA.
Supraventricular Tachycardia
1. Admit to:
2. Diagnosis: PSVT
3. Condition:
4. Vital signs: q1h. Call physician if BP >160/90, <90/60; apical pulse >130,
<50; R >25, <10; T >38.5
C
5. Activity: Bedrest with bedside commode.
6. Nursing:
7. Diet: Low fat, low cholesterol, no caffeine.
8. IV Fluids: D5W at TKO.
9. Special Medications:
Attempt vagal maneuvers (Valsalva maneuver and/or carotid sinus massage)
before drug therapy.
Cardioversion (if unstable or refractory to drug therapy):
1. NPO for 6h, digoxin level must be less than 2.4 and potassium and
magnesium must be normal.
2. Midazolam (Versed) 2-5 mg IV push.
3. If stable, cardiovert with synchronized 10-50 J, and increase by 50 J incre-
