OnlineMedEd: Cardiology - "ACLS Rhythms" Flashcards
Go through the first question in Dustyn’s EKG interpretation scheme.
“Is the rate fast or slow?”
- If fast, look at the QRS width.
- If slow, look at the
There are three fast, narrow-QRS rhythms: ______________.
SVT (greater than 150 BPM, regular, no P waves), atrial flutter (sawtooth pattern at 300 BPM atrial beating), and atrial fibrillation (irregularly irregular, chaotic background, no discernible P waves)
Go through the treatment protocols for SVT, atrial fibrillation, atrial flutter, torsades de pointes, and ventricular tachycardia.
- SVT: (1) vasovagal maneuvers, (2) adenosine, and (3) shock
- Atrial fibrillation: (1) rate control (BBs, CCBs) or rhythm control (amiodarone), (2) shock
- Atrial flutter: (1) rate control (BBs, CCBs) or rhythm control (amiodarone), (2) shock
- Torsades: (1) Mg, (2) shock
- Ventricular tachycardia: (1) amiodarone, (2) shock
Important: you only shock if they are unstable
Another point: “shock” means cardioversion, not defibrillation
What do ask when you see atrial fibrillation?
“Is it old or new?”
- If it started in the last 48 hours, then you cardiovert (medically or electrically).
- If it is older than 48 hours or you don’t know when it started, then you do a TTE and TEE echo (to see if it is valvular), then cardiovert, then coagulate.
Go through CHADSS.
- CHF
- HTN
- Age greater than 75
- DM
- Stroke
- Stroke
A score of two or more = anticoagulation.
Why do you need to do an echo in old atrial fibrillation to see the valves?
Valvular disease requires warfarin with a heparin bridge, while nonvalvular can be treated with either warfarin or novel oral anticoagulants and does not require a heparin bridge.
Go through the wide and narrow bradycardias.
- Wide: 3º heart block, intraventricular rhythm
* Narrow: 1º, 2º, and sinus bradycardia
How are bradycardic arrhythmias treated?
- Sinus bradycardia, 1º heart block, 2ºheart block: atropine or pacemaker
- 3º heart block, intraventricular rhythm: pacemaker
