2.  An 14 years old female came into the ER
complaining of sudden onset of
dizziness, palpitations, sweating and blurred
vision. She had cold, clammy skin and pallor.
Vital signs were HR = 188 bpm; BP =100/60
mm Hg; RR = 24 rpm. Full and equal pulses
 She was conscious but anxious

3. In CPR room
 Vital signs were checked again and humidified
oxygen was administered via nasal canulae and I.V.
access was established and ECG monitor was
attached
 An 12 leads ECG was done and show the following

5. SupraVentricular
Tachycardia

6. Steps we had done
 Starting by giving her fluid bolus 500 ml of normal
saline
 Try to slowing heart rate using vagal maneuver
(carotid massage) but no response .
 Consulting cardiologist.
 Then giving Amiodarone 150 mg over 20 min. with
ECG monitoring (no available Adenosine)
 Patient start to respond to amiodarone after 10 min.
on monitor

7.  2nd ECG done and showing
 Sinus Tachycardia

8. Reevaluation
 H.R. 148 bpm , BP 110/70 mm Hg , RR 18 rpm
 Improved symptoms (sweating
,palpitation, anxiety, pallor)
 No previous similar conditions.
 Have no chronic illness
 Physical examination had revealed any abnormalities

9. Out come
 Patient referred to CCU
 Echocardiography had done and no structural
abnormalities identified
 Patient advised to make Electrophysiological study
 Patient had home treatment in form of Inderal
“Propranolol”