SVT: Adequately Perfused (Adult)
 
Status
SVT with Systolic BP >100
             
Is Pt Symptomatic?
  No     Yes
Asymptomatic
Abdominal valsalva manoeuvre
 
Symptomatic
Abdominal valsalva manoeuvre
 
         
BLS  
Did SVT revert?
If Pt deteriorates, Mx as per Symptomatic or as SVT with less than Adequate Perfusion  
Yes
         No
   
BLS
   
If >30 minutes transport time and SOB with crackles or chest pain
Verapamil 5mg IV, given over 1 minute
- Repeat 1mg IV 1, minutely until either:
- Arrhythmia reversion
- BP <100
- max Verapamil 10mg IV
Verapamil is C/I for Pt on Beta blockers
             
Special Notes
Symptomatic signs and symptoms:
- Rate related severe or persistent chest pain
- Shortness of breath with crackles
 
General Care
Valsalva instruction

- Evidence suggests a greater reversion rate with an abdominal valsalva manoeuvre with the following 3 elements:
1. Position - Supine
2. Pressure - At least 40mmHg for max. vagal tone. Best achieved with Pt blowing into a 10ml syringe hard enough to move the plunger to create this pressure.
3. Duration - At least 15sec if tolerated by Pt

Ref. G Smith, A Morgans, and M Boyle Emerg Med J 2009; 26: 8-10. doi:10.1136 emj.2008.061572