Bradycardia & ALS Flashcards
What features indicate haemodynamic compromise? [4]
- shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
- syncope
- myocardial ischaemia
- heart failure
What is the first line treatment if someone is exhibiting bradycardia with sympptoms / evidence of life threatening signs? [1]
IV atropine 500 mcg
A patient is exhibiting bradycardia with signs of MI. You give 500mg of IV atropine.
There is no satisfactory response. What is the next step in management? [4]
- IV Atropine 500 mcg, repeat to maximum of 3mg
- Isoprenaline 5mcg IV
- Adrenaline 2-10mcg IV
OR
- Transcutaneous pacing
A patient is exhibiting bradycardia with signs of MI. You give 500mg of IV atropine.
There is no satisfactory response.
Next you give IV Atropine 500 mcg, repeat to maximum of 3mg;
or Isoprenaline 5mcg IV; or
Adrenaline 2-10mcg IV; or transcutaneous pacing.
There is still no satisfactory response. What is the next step? [1]
Seek expert help and arrange transvenous pacing
A patient has bradycardia and has no signs of shock / syncope / MI / HF but is at risk of asytole.
What are 4 conditions that means person is at risk of asytole? [4]
- Recent asytole
- Mobitz II AV block
- Complete Heart Block with broad QRS
- Ventricular pause > 3secs
A patient has bradycardia and has no signs of shock / syncope / MI / HF but is at risk of asytole.
What is the next appropriate managemet steps? [4]
Why might a patient not be started on both a beta-blocker and CCB, but instead just a CCB, for the first line treament of their angina? [1]
What would be the stepwise treatment if a CCB is not working? [1]
If the beta-blocker is contraindicated - e.g. if they have asthma
if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker then consider one of the following drugs:
* a long-acting nitrate
* ivabradine
* nicorandil
* ranolazine
Describe the treatment algorithm for ALS
- CPR 30:2
- Attach defibrillator
- Assess rhythm:
- If shockable (VF / Pulseless VT): one shock, then resume CPR for 2 min then assess rhythm again and repeat
- If non-shockable: immediately resume CPR for 2 mins and assess rhythm again
Adrenaline:
- 1 mg as soon as possible for non-shockable rhythms
- during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
- repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
amiodarone:
* 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
* a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
thrombolytic drugs:
* should be considered if a pulmonary embolus is suspected
* if given, CPR should be continued for an extended period of 60-90 minutes
State and describe the drug regimens used in ALS [3]
Adrenaline:
- 1 mg as soon as possible for non-shockable rhythms
- during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
- repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
amiodarone:
* 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
* a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
thrombolytic drugs:
* should be considered if a pulmonary embolus is suspected
* if given, CPR should be continued for an extended period of 60-90 minutes
Describe the dose and frequency of dosing of adrenaline in ALS [3]
Adrenaline:
- 1 mg as soon as possible for non-shockable rhythms
- during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
- repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
Describe the dose and frequency of dosing of amiodarone in ALS [3]
amiodarone:
* 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
* a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
When are thrombolytic drugs given in ALS? [1]
How long should you continue CPR after adminstering them in ALS? [1]
thrombolytic drugs:
* should be considered if a pulmonary embolus is suspected
* if given, CPR should be continued for an extended period of 60-90 minutes
What are the oxygen TS post successful resuscitation? [1]
94-98% - is to address the potential harm caused by hyperoxaemia
What are risk factors for asystole in bradycardia? [4]
Risk factors for asystole in bradycardia (? needs transvenous pacing)
* complete heart block with broad complex QRS
* recent asystole
* Mobitz type II AV block
* ventricular pause > 3 seconds
When performing ALS, under which conditions do you give 300mg amiodarone? [2]
Shockable rhythms:
- Amiodarone should be given to patients in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) AFTER they’ve recieved three shocks
- a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
When performing ALS, under which conditions do you give adrenaline? [1]
Non-shockable rhythms:
- adrenaline 1 mg as soon as possible
Shockable rhythms:
- adrenaline 1 mg is given once chest compressions have restarted after the third shock
repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
