Narrow complex tachycardias (AVNRT, AVRT) / Broad complex (VT)

Question 1

Which part of A-E does this affect?

Answer 1

Circulation

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: diaphoresis

Listen: fine crackles pulmonary oedema, vesicular sounds, decreased breath sounds (pneumonia -> sepsis)

Feel: chest expansion, tracheal deviation

O2 sats, RR

ABG - for lactate (quantify perfusion) and electrolytes

?XCR rule out pneumonia

Question 4

Circulation

Answer 4

Look for anaemia, diaphoresis

Listen S1,2 +0

Feel pulse (irregularly irregular and fast), apex beat undisplaced

HR: high
BP

Bloods: FBC, UEs, LFTs, CRP, troponin, d-dimer, cholesterol, lipids, glucose

Cannulas

ECG

Management:

If haemodynamically:

• Synchronised DC shock at 200J up to 3 times (sedation prior)
• Amiodarone 300mg/ 20 min
• Re-attempt shock

If not haemodynamically unstable:
- Escalate to senior reg/ cardio SpR
- Vagal manoeuvres
- Adenosine 6mg IV bolus
- Adenosine 12mg IV bolus
- Further 12 mg IV bolus

(avoid in asthma, COPD, HF, heart block)

Question 5

Management if broad complex seen

Answer 5

Give O2 if SaO2 < 90%, get IV access & 12 lead ECG

Adverse signs? Shock, chest pain, ischaemia, HF, syncope -> DC cardioversion followed by 300mg amiodarone over 20min

No adverse signs

• Regular rhythm: amiodarone 300 mg over 20 min. Then 900mg over central line

If irregular (polymorphic VT) expert help give Mg 2g IV over 10 minutes

Question 6

Disability

Answer 6

PEARL
glucose
GCS
neuro deficit
Drug chart (can cause AF)

Question 7

Exposure

Answer 7

Abdo exam
Rashes
Urine dip
Cathetirise (urine output)
Temp
Calves

Question 8

Management of narrow complex tachy

Answer 8