For adults, what is the indication for Adenosine (Adenocard) in ALS?

• A. Stable narrow-complex SVT or wide complex tachycardia
• B. Unstable tachycardia requiring immediate cardioversion
• C. Atrial fibrillation with rapid ventricular response
• D. Ventricular tachycardia with pulse

Answer: (A)

Adenosine is used in adults for stable, AV-node–dependent supraventricular tachycardias and is also considered when a wide complex tachycardia is believed to be SVT with aberrancy. It works by briefly blocking conduction through the AV node, which can terminate re-entrant SVTs that rely on the AV node and can reveal the true atrial activity. This makes it the best choice for a patient with a stable, narrow QRS tachycardia, and it can be considered in a wide-complex tachycardia only if SVT with aberrant conduction is suspected and the patient is stable. It is not appropriate for unstable tachycardia requiring immediate cardioversion, atrial fibrillation with rapid ventricular response, or ventricular tachycardia with a pulse, since adenosine targets AV-node–dependent circuits and can be ineffective or unsafe in those scenarios.