Peri-arrest rhythms

Question 1

Describe how you would manage a broad complex tachycardia.

Answer 1

determine if irregular or regular

if regular - assume VT
= IV amiodarone followed by 24 hour infusion

if irregular
- AF: <48hrs DC cardioversion or if > 48hrs then rate control + anticoagulation

• polymorphic VT (torsades de pointes)
  = IV magnesium sulphate

Question 2

describe how you would manage a narrow complex tachycardia.

Answer 2

determine if irregular or regular

if regular - assume SVNRT

• vagal manœuvres followed by adenosine
• if fails then assume atrial flutter and treat with beta blockers

if irregular
- AF: if < 48hrs then DC cardioversion but if > 48 hours treat with beta blockers and anticoagulation

Question 3

when would give DC cardioversion in a patient with a tachycarrythmia?

Answer 3

if patients was unstable (showed one of the following signs);

• shock: systolic < 90, cold clammy skin, confusion
• syncope
• heart failure
• myocardial ischaemia

Question 4

1st line management of bradycardia with haemodynamic compromise ?

Answer 4

IV atropine 500mcg

Question 5

if bradycardia still persists after atropine, what are the other treatment options ?

Answer 5

IV atropine, up to 3mg can be given
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response

transvenous pacing (specialist advise required)

Question 6

what are risk factors for systole in a patient with bradycardia ?

Answer 6

previous asystole
complete heart block with broad QRS complex
mobitz type II AV block
ventricular pause > 3 seconds