ACS

Question 1

Secondary prevention of ACS

Answer 1

Ace
Beta blocker
Statin
Clopi (or other platelet inhibitor)

Question 2

STEMI on ECG management

Answer 2

Immediate transfer for coronary angiography and primary percutaenos coronary intervention

Meds: Morphine, oxygen, nitrate, platelet inhibitor

Question 3

Treating polymorphic VT (torsades de pointes)

Answer 3

Magnesium 2g over 10 minutes

Question 4

Treating VT (broad complex tachycardia)

Answer 4

Amiodarone 300mg IV over 10-60 minutes

Question 5

Narrow complex tachycardia management

Answer 5

Vagal manœuvres (valsava)
If not effective
Adenosine (if no pre excitation) 6mg rapid IV bolus, if unsuccess 12mg, if unsuccess 18mg monitoring ECG continuously
If not effective
Verapamil or BB

Question 6

Atrial fibrillation management

Answer 6

Control rate with beta blocker (diltiazem if asthmatic)
Consider digoxin / amiodarone if evidence of heart failure
Anticoagulants if >48 hours

Question 7

What features indicate need for shock

Answer 7

Shock
Syncope
Myocardial ischaemia
Severe heart failure

Question 8

If arrhythmia persists post shock (3)

Answer 8

Give 300mg amiodarone IV over 10-20 min then 900mg IV over 24h

Question 9

Treating SVT (narrow complex tachycardia)

Answer 9

6mg rapid IV bolus adenosine

Question 10

The defib should be set to

Answer 10

Synchronised shock

Question 11

Broad complex tachycardia - VT defib setting

Answer 11

120-150 J biphasic shock increasing in increments

Question 12

AF defib setting

Answer 12

Highest possible

Question 13

Atrial flutter and narrow complex tachycardia (SVT) defib setting

Answer 13

70-120 J

Question 14

Pad positioning for AF or flutter

Answer 14

Anteroposterior

Question 15

Bradycardia with SSSM or risk of asystole (recent, mobitz 2, complete block, ventricular pause)

Answer 15

1. Atropine 500mcg IV to a max of 3mg
2. Isoprenaline 5mcg
3. Adrenaline 2-10mcg

Question 16

Bradycardia with no life threatening signs or risk of asystole management

Answer 16

Observed