chapter 11: peri-arrest arrythmias

Question 1

what are the life threatening features

Answer 1

1) shock
2) syncope
3) myocardial ischemia
4) severe heart failure
5) extreme heart rate (>150, <40)

Question 2

management of tachyarrhythmia with life threatening features

Answer 2

synchronised cardioversion ( up to 3 attempts)
if unsuccessful, 300mg amiodarone IV
repeat shock
then 900mg/24hr

Question 3

Management of regular broad complex tachy

Answer 3

if VT- Amiodarone 300 mg IV/ 1hr then 900mg/24hr

Question 4

Management of regular narrow complex tachy

Answer 4

vagal manoeuvres
adenosine 6mg IV bolus>12mg>18mg
Monitor ECG
Verapamil/beta blocker

Question 5

Management of regular narrow complex tachy without pulse

Answer 5

synchronised cardioversion

Question 6

Management of AF

Answer 6

Control rate with beta blocker
Digoxin/amiodarone if heart failure
anticoagulate if duration>48h

Question 7

what to do if AF>48h

Answer 7

Anticoagulation prophylaxis for 3 weeks before cardioversion
If needed immediately, give heparin
echo ( rule out atrial thrombus)

Question 8

if AF<48h

Answer 8

chemical cardioversion with propfenone/flecainide
electric cardioversion