Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

A 20 year old dental student has been taking tablets to help her revive when tired.  She presents to the ED with palpitations associated with anxiety. Her BP is 110/70.

What does the EKG show and what is the diagnosis?

Rate:    170

Rhythm:  regular narrow complex tachycardia

Axis:    normal

PR:    not clearly discernible

QRS:   narrow complex

ST:    T flat to inverted in I, AVL

EKG Diagnosis: -regular narrow complex tachycardia

Clinical Diagnosis: -supraventricular tachycardia induced by caffeine or amphetamines

• Practice Points: -SVT may be precipitated by stimulants such as caffeine, ephedrine, or amphetamines
• -always be careful to check that a narrow complex tachycardia is truly regular as occasionally rapid atrial fibrillation can appear regular at first glance
• -remember vagotonic maneuvers first before resorting to adenosine for SVT
• -right sided carotid sinus massage in the supine patient is the most effective method.  Valsalva maneuvers in the adult are an alternative

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