Continuing Professional Development: Understanding arrhythmias: paroxysmal supraventricul artachycardia in the prehospital setting

OverviewParoxysmal supraventricular tachycardia (PSVT) presents a challenging assessment to the prehospital emergency care provider. The nature of PSVT affects all age groups, has a range of aetiologies, is usually well tolerated but may also result in sudden cardiac arrest. It is able to be terminated by a range of therapies and is the subject of an evolving understanding of pathophysiology related to it. Therefore, it is essential that those providing prehospital care have an understanding of the nature and implications of PSVT in order to effectively manage this condition in the field. This module will use a systematic approach to highlight the pathophysiology, epidemiology, interventions, and issues, to arm the reader with the necessary knowledge to approach this patient with confidence.Learning OutcomesAfter completing this module you will be able to:• Discuss the pathophysiology of supraventricular tachycardia (SVT) (atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT)) in relation to physiological effects on the body, specifically perfusion and likely deterioration to lethal arrhythmias.• Discuss the treatment modalities available in the prehospital setting for paroxysmal supraventricular tachycardia (PSVT)—specifically the use of vagal manoeuvres, pharmacological agents, and synchronized cardioversion.• State the evidence-based components of the valsalva manoeuvre (VM), and describe their effect.• Describe the rationale for use of the VM in the setting of haemodynamically stable SVT as a firstline intervention.• Outline the controversies and continued development of the VM, and how this may impact upon current reversion rates for SVT.

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