asked 3 days ago
I heard of a crew that was ordered by the BHP to shock a rapid SVT rhythm in a pulseless patient. It is my understanding that this is a very rare event. If we encounter this, do we treat it as a PEA or should we try to patch and get approval to shock since SVT is not one of the two rhythms that we are authorized to shock? There is an ACP Tachydysrhythmia protocol that gives direction on shocking SVTs, would this even be within our PCP scope of practice? Thanks.
1 Answers
answered 22 hours ago
Thank you for the question. Not knowing the exact details of the case, I will respond as best possible. SVT is usually a very stable rhythm. Most patients can be in SVT for prolonged periods without becoming unstable. If a patient were to become unstable, synchronized cardioversion is the mainstay of treatment. If this patient was truly VSA (and not just severely hypotensive) I would still consider electrical treatment to help restore the rhythm. Whether I would use synchronized cardioversion vs defibrillation would depend on the timing and the story. If I felt the patient was in true SVT and just hypotensive, I would use cardioversion. If there was doubt about the underlying rhythm I would consider defibrillation. The electrical treatment of SVT is a mandatory patch point and only part of the ACP scope of practice. For PCPs , I would still patch for guidance and possible defibrillation orders.
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