List Archives

Wed Jan 3 19:25:26 GMT 2007

Watching Eli Manning scrammble in the pocket......gives me VT

Ronald Gross <Rgross at harthosp.org> wrote:  The New York Giants ARE causing SVT - but then again so are the Rangers,
if you happen to be a long suffering fan!!! And that is, in fact, my
dear friend, TRAUMA! ;-)

Now, back to trauma............

>>> "Bjorn, Pret" 
1/3/2007 1:40 PM >>>
NYG? The New York Giants are causing SVT?

You're right: this ain't trauma. Maybe we can answer it quick and get
outta here.

First, without an ECG to look at -- probably even WITH one -- you have
to wonder about the working diagnosis. SVT is an uncommon declaration
given a rate that low (even prorating for age). Tell me about her
p-waves. And it'd be interesting to know what her heart rate was when
you met her, and after the adenosine "converted" her.

But trusting this conclusion nonetheless, I'm sure you understand that
SVT is not a compensatory response to anything. It's an irritability
and/or aberrant conduction phenomenon, which may have been touched off
by the effects of the nitro, or her endogenous catecholamines, or bad
luck (odds increasing from the former to the latter). 

In the end, though, it doesn't really matter. You can't take much
useful from this case; all you can do is become more hesitant to give
nitrates to patients with chest pain. Depending on your knowledge and
experience level, this may be a good or bad effect.

Back to trauma, then. Hope this helps a bit.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of David Sullivan
Sent: Tuesday, January 02, 2007 5:09 PM
To: Trauma & Critical Care mailing list
Subject: NYG induced SVT

Hello All, 

I know that this list is more trauma based education, and cases, but I
came across a "routine" medical call and got a strange answer from the
MD that accepted my pt. here it is 

82 yoF from Nursing home, pt c/o 6/10 c/px 30mins, staff admin 1 NTG
tab, and her pressure droped to 80/40 the called EMS, we found her in
bed CAOx4, still c/o of the chest pain, her vitals where 140, 90/60, 22,
l/s CTAB. bs 184mg/dl pt was moved to the ambo where there was no acute
change, IV, o2, monitor, and 12 lead EKG done, along with a right sided
12-lead too 162mg asprin PO. her rate didnt change and bounced back
between high 130s and mid 140s.

while I was finishing my trip sheet, the MD told me that she broke her
SVT w/ adenosine, and that she was doing better. I asked her why, and
she told me that NTG can induce SVT, I understand why pts become
tachacardic as a compensatory mechanism for the vasodialation, but the
NTG must have worn off within 10 min transport. I was very confused, any
help would be appreciated 

dave sullivan BA NREMT-P
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NYG induced SVT