ECG

Question 1

Shockable rhythms

Answer 1

Pulseless VT
Pulseless VF

Question 2

Non shockable rhythms

Answer 2

Pulseless asystolie
Pulseless electrical activity

Question 3

Management of sinus tachycardia if no pulse

Answer 3

ACLS

Question 4

Management Sinus tachycardia if pulse

Answer 4

ABC
Monitoring
Correct electrolytes
If still not stable ->. Synchronized DC shock
If stable -> vagal maneuvers or give adenosine

Question 5

Answer 5

Sinus bradycardia

Question 6

Causes of sinus bradycardia

Answer 6

Normal in athletic patient
MI
Hypothyroidism
Hypothermia
Hyperkalemia
Sick sinus syndrome
Drugs (BBlocker, digoxin, anticholinesterase erase, halothane, sux)

Question 7

Answer 7

Sinus bradycardia

Question 8

causes of sinus bradycardiardia

Answer 8

oNormal athletes
Drugs - bblocker, digoxin
MI
sick sinus syndorme
Raised ICP
Hypovolemiathyroisidm y

Question 9

Management of sinus bradycardia

Answer 9

Correct underlying cause
No correction if person healthy and HR>40bpm
Incremental dose of atropine up to 20mcg

Question 11

Causes of sinus tachycardia

Answer 11

Inadequate depth of anaesthesia
Pain
Surgical stimulation
Fever sepsis
Anemia
Shock
Thyrotoxicosis
Drugs - atropine ktamine

Question 12

Answer 12

Atrial fibrillation

Question 13

ECG features of atrial fibrillation

Answer 13

Irregularly irregular rate - variable ventricular rate
No P waves
QRS <120ms

Question 14

AF management

Answer 14

Determine if presence of shock, syncope, MI , ,heart failure

If stable - correct underlying cause , rate control (BBlocker esmolol 0.5mg/kg IV bolus over 1min or amiodaroneif hfref) or rhythm control (DC cardio version or amiodarone 300mg IV over 1h and 900mg over 23h) management possible

If unstable - urgent synchronized DC cardio version 120-150j and increase
Anticoagulants

Question 16

Answer 16

Atrial flutter

Question 17

Atrial flutter features on ecg

Answer 17

Narrow complex tachycardia
Loss of isooelectric baseline
saw tooth pattern
Inverted flutter in leadsII, III, avF

Question 18

Management atrial flutter

Answer 18

Hemodynamic unstable -> synchronized DCCV (GAor sedation)

Stable -> vagal manœuver , carotid sinus massage, vasalva,, adenosine 6mgIV followed by 0.9% nacl

Rate and rythm control - bblockk or amiodarone

Question 19

Ventricular ectopics features on ecg

Answer 19

Broad QRS complex (more than 0.12s or 3 boxes)
Premature
Discord a tST and T wave changes

Question 20

Management ventricular ectopics

Answer 20

Correct reversible causes
If sinus rythm slow less than 50bpm -> increase IV atropine or glycopyrronium

Question 21

Answer 21

Ventricular tachycardia

Question 22

VT features on ECG

Answer 22

Regular broad complex tachycardia
Uniform QRS

Question 23

Triggers of VT

Answer 23

MI
Hypoxia
Hypotension
Fluid overload
Electrolyte imbalance
Adrenaline and catecholamines
Drug which prolong QT interval

Question 24

Management of VT

Answer 24

Pulseless VT -> CPR and ACLS
VT with pulse -> if adverse features do synchronized DCCV , if no adverse features amiodarone 300mg IV over 20-1h then 900 mg over 23h

Question 25

Answer 25

Torsades de pointes

Question 26

Management torsades de pointes

Answer 26

If compromise -> Immediate defibrillation even if pulse If stable -> give Mg2+2g IV 10-20mins, infusion at 1-4g/h Monitoring plasma levels

Question 27

Answer 27

Ventricular fibrillation

Question 28

Management ventricular fibrillation

Answer 28

Immediate DCCV

Question 29

Answer 29

MI

Question 30

Features MI

Answer 30

St elevation St depression T wave inversion New onset bbb Old MIwith pathological Q waves

Question 31

Management MI

Answer 31

ICU MONA- O2, morphine IV, aspirin PO, SL glyceryl trinitrine Definitive management Treat Heart failure Investigations - 12 lead ECG, cardiac enzymes, echo

Question 32

Do you need to investigate or treat a first-degree heart block?

Answer 32

No

Question 33

Per management of a patient with a third of second-degree heart block

Answer 33

ABC If hypertension isoprenaline Transcutaneous pacing

Question 34

Indication for preoperative pacing in heart block

Answer 34

Symptomatic first-degree heart block Second-degree or thirddegree heart block Sinus node, disease, symptomatic

Question 35

Answer 35

First degree heart block

Question 36

Features first degree heart block

Answer 36

Increased PR interval more than 200ms

Question 37

Causes of first degreee heart block

Answer 37

Increased vagal tone Athletic training Inferior MI Mitral valve surgery Myocarditis Electrolyte disturbances Dugs like bb, ccb, digoxin, amiodarone r

Question 38

Answer 38

Morbitz type i

Question 39

ECG features mobitz type 1

Answer 39

Progressive prolongation of PR interval

Question 40

ECG features mobbitz type 2

Answer 40

Intermittent non conducting p waves with no progressive prolongation of pr interval

Question 41

Answer 41

Mobitz type 2

Question 42

Causes of mobitz type 2

Answer 42

Anterior mi Idiopathic fibrosis Cardiac surgery’Inflammatory conditions Autoimmune conditions Infiltrative myocardial dx Hyperkalemia Drugs bb , ccb, digoxin, amiodarone

Question 43

Answer 43

Hypokalemiaalemia

Question 44

Causes of complete heart block

Answer 44

Inferior MI Drugs Idiopathic

Question 45

Answer 45

Complete heart block

Question 46

Answer 46

Hypokalemia

Question 47

Feature hypokalemia

Answer 47

T wave inversion St depression Prominent U wave

Question 48

Management of hypokalemia

Answer 48

Admit Monitoring with ECG Central line -> KCL Urethral catheter to monitor urine output

Question 49

Hyperkalemia features on ecg

Answer 49

Tall T waves P wave flattening PR prolongation Wide QRS

Question 50

Answer 50

Hyperkalemia

Question 52

Hyperkalemia management

Answer 52

if K+ more than 6.5mmol/LL or ECG changes ABC Monitoring with ECG IV access - insulin 10U+ 50ml 50%dextrose over 30mins to 1h Calcium gluconate 5-10mls of 10% or calcium chloride 3-5mls of 10% If severe consider dialysis B2 agonists