A 26-year-old female presents to the triage desk with sudden palpitations. ECG reveals regular narrow-complex tachycardia at 190 bpm without P waves. Blood pressure is 118/76 mmHg. Vagal maneuvers fail. What is the next pharmacological intervention and dosage?

Answer and explanation

Correct answer: A. Adenosine 6 mg rapid IV push followed immediately by a 20 mL rapid saline flush

  1. Step 1: The patient has hemodynamically stable paroxysmal supraventricular tachycardia (PSVT).
  2. Step 2: First-line non-pharmacological therapy is vagal maneuvers. If unsuccessful, the first-line pharmacological treatment is Adenosine 6 mg given as a rapid IV push via a large peripheral vein followed immediately by a 20 mL normal saline flush.
  3. Step 3: If PSVT persists after 1-2 minutes, a second dose of 12 mg rapid IV push may be administered.
Answer
Adenosine 6 mg rapid IV push followed immediately by a 20 mL rapid saline flush.
Why not the others: Synchronized cardioversion is indicated for unstable SVT; Amiodarone and Diltiazem are second-line agents if adenosine fails or is contraindicated.

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