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Flashcards in Arrythmia Management Deck (41):
1

 

 

How would you initially manage someone with an arrythmia?

ABCDE approach

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

2

 

 

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

 

 

Commence ALS algorithm

3

 

 

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

4

 

 

How would you manage a tachyarrhythmia with adverse signs?

 

 

Synchronised DC cardioversion

5

 

 

How would you manage bradycardia with adverse signs?

 

 

Atropine +/- pacing

6

 

 

How would you manage sinus tachycardia?

 

 

Treat the cause

7

 

 

How would you manage paroxysmal SVT?

 

 

 

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

8

 

 

When would you not use adenosine to treat paroxysmal SVT?

 

 

Asthmatics - use CCB

9

 

 

How would you manage AF?

 

  • Rate Control
  • Rhythm Control
  • Anticoagulation

10

 

 

When would you use rate control to treat AF?

 

 

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

11

 

 

What medications are used for rate control in AF?

 

  • Beta blocker
  • Diltiazem
  • Digoxin

12

 

 

When is digoxin used to manage AF?

 

  • Sedentary lifestyle
  • Hypotension
  • Heart Failure

13

 

 

When would you consider rhythm control for controlling AF?

 

 

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

14

 

 

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

15

 

 

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

 

  • Flecanide
  • Amiodarone

16

 

 

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

 

 

Narrow and broad complex tachycardias

17

 

 

What are the main recognised narrow complex tachycardia rhythms?

 

  • Sinus Tachycardia
  • Paroxysmal SVT
  • Atrial Fibrillation/Flutter

18

 

 

What are the recognised Broad complex tachycardia rhythms?

 

  • Ventricular tachyarrythmias
  • Broad complex tachycardias of SV origin

19

 

 

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

20

 

 

What are examples of Ventricular tachyarrythmias?

 

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

21

 

 

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

22

 

 

How would you manage monomorphic VT with a pulse?

 

 

Amiodarone

23

 

 

How would you manage polymorphic VT?

 

 

Magnesium Sulphate

24

 

 

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

25

 

 

How would you manage SVT with aberrant conduction?

 

 

Treat as for SVT

26

 

 

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

 

 

Flecanide or DC cardioversion

27

 

 

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

28

 

 

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

29

 

 

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

 

Assess risk of asystole

30

 

 

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

 

 

Give atropine

31

 

 

What are causes of bradycardia?

 

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

32

 

 

What are causes of sinus bradycardia?

 

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

33

 

 

What types of AV node dysfunction can cause bradycardia?

 

 

2nd/3rd degree HB

34

 

 

What can sick sinus syndrome result in?

 

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

35

 

 

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

 

Assess risk of asystole

36

 

 

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

 

37

 

 

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

38

 

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

39

 

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

40

 

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

41

 

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