Alex Sharp
Journal of Paramedic Practice, Vol. 7, Iss. 12, 08 Dec 2015, pp 618 - 628

Background: Tachycardia is a common finding within the unwell patient and
can occur as a normal physiological response or as a result of an underlying
arrhythmia. Supraventricular tachycardia (SVT) is a common cardiac arrhythmia
which can be treated through a range of differing techniques. The aim of
this review was to identify whether the current evidence base supports UK
paramedic practice and whether the treatment provided could be enhanced.
Methods: A literature review through the databases CINAHL, Pubmed and
Medline was carried out, using a Boolean search strategy. Articles were included
within the study if they discussed the management of SVT through the use of the
Valsalva manoeuvre, carotid sinus massage or adenosine within the hospital or
pre-hospital environment.
Results: A total of 32 papers were identified for possible inclusion, with
18 papers being included. The Valsalva manoeuvre was shown to be the most
effective vagal manoeuvre, with reversion rates of 21.4-27.7% within the
pre-hospital environment. The use of adenosine was shown to be effective in
reverting SVT, with most total reversion rates being 80.7-100%. The initial
6 mg dose was shown to have lower efficacy than the subsequent 12 mg doses.
Correct paramedic identification rates of SVT were greater than 75%.
Conclusions: The Valsalva manoeuvre has been shown to be effective and
potentially more effective the quicker it is used following onset of the SVT. The
safe use of adenosine by paramedics within the US and Australia support the
introduction of adenosine into UK paramedic practice.

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