Supraventricular tachycardia (SVT) is a condition where your heart suddenly beats much faster than

normal. It's not usually serious, but some people may need treatment or Emergency medical support.

Managing SVT in the emergency room (ER) involves a step-by-step approach. Here's a concise algorithm
for managing SVT in the ER:

1. Assessment:

 Confirm the diagnosis of SVT based on clinical signs, symptoms, and ECG findings.

 Assess the patient's hemodynamic stability.

2. Vagal Maneuvers:

 Attempt vagal maneuvers as the first-line intervention.

 Techniques include carotid sinus massage, Valsalva maneuver, or cold water face
immersion.

3. Adenosine Administration:

 If vagal maneuvers are unsuccessful or contraindicated, administer adenosine as the

initial pharmacologic treatment.

 Administer a rapid IV bolus (usually 6 mg) followed by a saline flush, and observe for
response.

4. Repeat Adenosine:

 If the initial dose is ineffective, a second dose of adenosine (12 mg) may be
administered.

5. Consider Calcium Channel Blockers or Beta-Blockers:

 If adenosine is unsuccessful or contraindicated, consider using calcium channel blockers

(e.g., verapamil) or beta-blockers (e.g., metoprolol) for rate control.

6. Electrical Cardioversion:

 In cases of hemodynamic instability or failure to respond to medications, synchronized

electrical cardioversion may be necessary.

7. Identify and Treat Underlying Causes:

 Investigate and address potential triggers or underlying causes of SVT (e.g., electrolyte
imbalances, ischemia, structural heart disease).

8. Admit or Discharge:

 Based on the patient's response to treatment and underlying conditions, decide whether
to admit for further management or discharge with appropriate follow-up. That being
said, as of my last update, the general algorithm for managing Supraventricular
Tachycardia (SVT) according to AHA/ACC guidelines included the following steps:
 1. Assessment:

 Confirm the diagnosis of SVT based on clinical presentation and ECG findings.

 Assess the patient's hemodynamic stability.

2. Vagal Maneuvers:

 Attempt vagal maneuvers as the initial step. These may include carotid sinus massage,
Valsalva maneuver, or cold water face immersion.

3. Adenosine Administration:

 If vagal maneuvers are unsuccessful, consider adenosine as the first-line pharmacologic

intervention.

 Administer adenosine rapidly as a bolus followed by a saline flush, while monitoring the
patient closely.

4. Repeat Adenosine or Use Alternative Medications:

 If the initial adenosine dose is ineffective, a second dose may be considered.

 Alternatively, calcium channel blockers (e.g., verapamil) or beta-blockers (e.g.,

metoprolol) may be used for rate control.

5. Electrical Cardioversion:

 If the patient is hemodynamically unstable or medications fail to restore normal sinus

rhythm, consider synchronized electrical cardioversion.

6. Identify and Treat Underlying Causes:

 Investigate and address any potential triggers or underlying causes of SVT (e.g.,
electrolyte imbalances, ischemia, structural heart disease).

7. Consider Long-Term Management:

 Discuss long-term management options, which may include medication

(antiarrhythmics), catheter ablation, or other interventions based on the underlying
cause and patient characteristics.

Always adapt the algorithm to the individual patient's clinical condition and any contraindications. For
the most up-to-date and specific guidelines, refer to the latest AHA and ACC guidelines or consult with a
healthcare professional.