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Flashcards in Arrythmia Management Deck (41):



How would you initially manage someone with an arrythmia?

ABCDE approach

  • Assess for adverse signs
  • Apply cardiac monitoring
  • Review ECG




If someone with an arrythmia had no pulse, what would you do?



Commence ALS algorithm




What are adverse signs associated with arrythmias which would prompt immediate intervention?


  • Syncope
  • Shock (SBP <90)
  • Myocardial ischaemia  - chest pain or on ECG
  • Heart Failure




How would you manage a tachyarrhythmia with adverse signs?



Synchronised DC cardioversion




How would you manage bradycardia with adverse signs?



Atropine +/- pacing




How would you manage sinus tachycardia?



Treat the cause




How would you manage paroxysmal SVT?




  • First line - Vagal manoevure
  • 2nd line - adenosine 
  • 3rd line - B-blocker




When would you not use adenosine to treat paroxysmal SVT?



Asthmatics - use CCB




How would you manage AF?


  • Rate Control
  • Rhythm Control
  • Anticoagulation




When would you use rate control to treat AF?



>65 yrs and has IHD/is not suitable for cardioversion




What medications are used for rate control in AF?


  • Beta blocker
  • Diltiazem
  • Digoxin




When is digoxin used to manage AF?


  • Sedentary lifestyle
  • Hypotension
  • Heart Failure




When would you consider rhythm control for controlling AF?



If patient is < 65 and doesn't have IHD/is suitable for cardioversion




How would you approach rhythm control in someone with AF?

Assess when it started:

  • If <48 hours and -ve TOE - electrical/pharmacological intervention
  • If >48 hours - 4 weeks anticoagulation then ehythm control




What pharmacological approaches can be used for rhythm control in AF?


  • Flecanide
  • Amiodarone




What two broad categories of tachycardia are recognised in the Peri-arrest algorithm?



Narrow and broad complex tachycardias




What are the main recognised narrow complex tachycardia rhythms?


  • Sinus Tachycardia
  • Paroxysmal SVT
  • Atrial Fibrillation/Flutter




What are the recognised Broad complex tachycardia rhythms?


  • Ventricular tachyarrythmias
  • Broad complex tachycardias of SV origin




If someone had a narrow complex tachycardia with no adverse signs, what would you want to distinguish before determining how to manage the patient?



Whether it was regular or irregular




What are examples of Ventricular tachyarrythmias?


  • Monomorphic VT
  • pVT
  • Polymorphic VT/Torsades de pointes




What would you want to assess if someone had monomorphic VT before deciding how to manage them?

Whether they had a pulse

  • Pulseless = ALS algorithm
  • Pulse = amiodarone




How would you manage monomorphic VT with a pulse?







How would you manage polymorphic VT?



Magnesium Sulphate




What are examples of broad complex tachyarrythmias of SV origin?


  • SVT with aberrant conduction - SVT or AF with R/LBBB
  • AF/Flutter with pre-excitation




How would you manage SVT with aberrant conduction?



Treat as for SVT




How would you manage AF/flutter with pre-excitation?



Flecanide or DC cardioversion




How would you distinguish broad complex tachycardia of SV origin from VT?

Mimics VT

  • SV origin if - Previous ECG with BBB, Delta waves, same shape QRS or irregular QRS
  • Not SV origin - QRS > 160, L axis deviation, AV dissociation




What bradycardias are at risk of asystole?


  1. Recent asystole
  2. Mobitz II AV block
  3. Complete HB with broad QRS
  4. Ventricular pauses > 3 secs




If someone with bradycardia was showing no adverse signs, what would you want to do?


Assess risk of asystole




If someone with bradycardia was showing adverse signs, what would you do?



Give atropine




What are causes of bradycardia?


  • Sinus bradycardia
  • SA node dysfunction (sick sinus syndrome)
  • AV node dysfunction (heart block)




What are causes of sinus bradycardia?


  • Drugs
  • Neurally mediated syndromes - carotid sinus hypersensitivity, vasovagal
  • Hypothermia
  • Hypothyroidism
  • SA node dysfunction




What types of AV node dysfunction can cause bradycardia?



2nd/3rd degree HB




What can sick sinus syndrome result in?


  • Sinus bradycardia
  • Sinus pauses
  • SA arrest with escape rhythms




If you had treated a bradycardia with adverse signs with atropine and response was satisfactory, what would you do next?


Assess risk of asystole




If someone with bradycardia initially treated with atropine was still displaying haemodynamic compromise, what options are evailable for management?


  • Atropine IV repeat to max of 3 g
  • Transcutaneous pacing
  • Isoprenaline/adrenaline infusion





What are indications for permanent pacing in someone with bradycardia?


  • Mobitz II HB
  • 3rd Degree HB
  • Symptomatic bradycardias
  • Symptomatic pauses
  • Trifascicular block with syncope/pre-syncope



Describe the following for adenosine use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing


  1. 6mg IV
  2. IV - wide bore cannula with immediate flush
  3. 12mg followed by 12 mg



Describe the following for amiodarone use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing



  1. 300 mg IV
  2. IV over 20-60 minutes
  3. 900mg over 24 hours through large vein



Describe the following for atropine use in arrythmia management:

  1. Dose
  2. Route and procedure of admin
  3. Subsequent dosing
  4. Max dosing


  1. 500 mcg IV
  2. IV
  3. Repeat 500 mcg every 3-5 mins 
  4. 3 mg



Describe the following for magnesium sulphate use in arrythmia management:

  • Dose
  • Route and procedure of admin
  • Subsequent dosing


  1. 2g IV
  2. IV over 10-15 minutes
  3. Nil