What is the initial intervention in a patient with sinus tachycardia with the following vital signs
HR, 136 beats/min; BP, 102/60 mm Hg; RR, 24 breaths/min; T, 99.2Â ° F; SpO2, 94% on oxygen 2 L/min by nasal cannula?
a. Stat adenosine to decrease heart rate
b. Identification and correction of the cause of the increased heart rate
c. Sublingual nitroglycerine 0.4 mg
d. Lidocaine 75 mg IV push
B
Sinus tachycardia can be caused by a wide variety of factors, such as exercise, emotion, pain, fever, hemorrhage, shock, heart failure, and thyrotoxicosis. Illegal stimulant drugs such as cocaine, "ecstasy," and amphetamines can raise the resting heart rate significantly. Many medications used in critical care can also cause sinus tachycardia; common culprits are aminophylline, dopamine, hydralazine, atropine, and catecholamines such as epinephrine. This patient has a stable heart rate and SpO2; therefore, there is time to identify the cause of the sinus tachycardia. Lidocaine is indicated for ventricular dysrhythmias. Nitroglycerine is not indicated because the patient is not having chest pain at this time. Adenosine is usually not indicated unless the heart rate is greater than 150 beats/min.
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