Answer
1) ECG shows the features of Paroxysmal Supraventricular Tachycardia (Abnormally narrow-complex tachycardia, regular, rapid rhythm)
2) Paroxysmal Supraventricular Tachycardia precipitate by Upper respiratory tract infection.
Notes: The correct diagnosis is crucial and need to differentiate condition likes Wolf Parkinson White syndrome (present of delta wave before QRS complex) as main pharmacological treatment for PSVT may caused DEATH due to cardiac arrest in WPW syndrome as it block the AV node pathway and cause abnormality in electrical activity due to accessory pathway.
3) Management
1) This is emergency cases whereby patient might crash; therefore he should be managed in Red zone with the presence of resuscitation team.
2) Ensure the airway is intact. Intubation is required in comatose patient.
3) Give oxygen via high flow mask
4) Obtain the IV access to the patient as nearer to the heart as possible (we will consider the usage of adenosine which is ultra rapid short acting, half life 60 seconds)
5) Close monitoring of the vital sign.
6) Attach the cardiac monitoring and get the cardioversion ready.
7) Re access the condition of the patient whether
a) He is awake or not
b) Stable vs non stable and follow the algorithm below.
8) Try the non pharmacological approach if patient stable.
9) The main choice of drug is adenosine. If unsuccessful, may consider amiodarone and lidnocaine.
10) Always beware of wolf Parkinson white syndrome because few drugs may lead to ventricular tachycardia and finally cardiac arrest
A- Adenosine
B- Beta blocker
C- Calcium channel blocker
D- Digoxin
11) If pharmacological treatment fail, use cardioversion (un synchronized)
12) If un synchronized cardioversion fails after few trial, consider synchronized cardiovert.
13) Once patient stabilize, transfer to the CCU for observation.