Step 1: Indication

• Symptomatic Tachydysrhythmias

Step 2: Conditions to Treat SVT

• Age: >= 18 years
• LOA: Unaltered
• HR: >= 150 bpm
• SBP: Normotension
• Other: Narrow Complex and Regular Rhythm

Step 3: Identifying SVT

• HR: >= 150 bpm
• P Waves: Missing/Non-Discernable
• QRS Complex: Narrow Complex (<120 msec)
• Rhythm: Regular

Step 4: Contraindications

• Sinus Tach
• A-Fib
• A-Flutter

Step 5: Modified Valsalva

• Place the Pt. semi-recumbent
• Instruct Pt. to exhale forcefully (strain) into a 10ml syringe for 15 secs.
• Followed by passive leg raising into a supine position at 45 degrees for 15 secs.
• 2 attempts per patient

Step 6: ACPs Management

• Consider Adenosine
• MPP for consideration of Synchronized Cardioversion
  • SBP: Hypotension
  • Other: Altered LOA, ongoing chest pain, other signs of shock

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