Adenosine for PSVT

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Adenosine for PSVT (ACLS)
- Adenosine is commonly used for the treatment of Paroxysmal Supraventricular Tachycardia (PSVT).
- It acts by blocking the AV node and interrupting the re-entry circuit responsible for tachycardia, restoring normal sinus rhythm.
- The initial recommended dose is 6 mg, given as a rapid intravenous bolus, followed by a flush of normal saline.
- If the first dose doesn't terminate the tachycardia, a second dose of 12 mg may be administered.
- Adenosine has a short half-life and may cause a brief period of asystole or bradycardia immediately after administration.

The 2-syringe technique
The 2-syringe technique allows for the adenosine to be delivered rapidly and efficiently, optimizing its effectiveness in terminating PSVT. It ensures that the medication is promptly delivered to the patient's systemic circulation, enhancing its ability to reach the cardiac tissue and interrupt the re-entry circuit responsible for the tachycardia.
1. Prepare two syringes: One syringe contains the adenosine medication while the other syringe is filled with a saline flush solution. Connect the two syringes using a three-way stopcock or a Y-site adapter. This allows for simultaneous administration of the adenosine and the saline flush solution.
2. Ensure proper venous access: A large-bore intravenous line is typically used to facilitate the rapid delivery of the medication, preferably in the upper extremities.
3. With the patient's heart rhythm being continuously monitored, administer the adenosine as a rapid intravenous bolus through one of the syringes. 
4. Immediately after injecting the adenosine, promptly and simultaneously flush the medication with the saline solution by opening the stopcock or activating the Y-site adapter. This helps ensure that the adenosine reaches the systemic circulation quickly.
5. Elevate the patient’s arm to expedite medication delivery
6. Observe the patient closely for any therapeutic response or adverse effects, which may include a temporary pause in the heart rhythm or a brief period of bradycardia.

Adenosine dosage
- The recommended initial dose of adenosine varies based on specific patient circumstances. Central lines administration, heart transplant patients, or patients using carbamazepine or dipyridamole: The initial dose should be reduced to 3 mg. In patients who have recently consumed caffeine, theophylline, or aminophylline: The initial dose can be increased to 12 mg.
- It is contraindicated in patients with second or third-degree heart block, sinus node dysfunction, and patients with atrial fibrillation associated with WPW syndrome.