Peri-arrest arrhythmias Flashcards
(33 cards)
What are the two main categories of arrhythmias in the ‘peri-arrest’ period?
- Arrhythmias that may lead to cardiac arrest
- Arrhythmias that occur after initial resuscitation from cardiac arrest
What are the categories of arrhythmias based on heart rate?
- Tachyarrhythmias
- Bradyarrhythmias
- Arrhythmias with a normal heart rate
Most peri-arrest arrhythmias fall into the first two categories.
What should be assessed when an arrhythmia is present or suspected?
- Condition of the patient
- Heart rate
- Nature of the arrhythmia
Documenting these factors is crucial for determining treatment.
What indicates that a patient with arrhythmia is unstable?
- Shock
- Syncope
- Heart failure
- Myocardial ischaemia
- Extremes of heart rate
Adverse features dictate the urgency and choice of treatment.
What is the preferred treatment for an unstable patient with adverse features?
Electrical treatment (e.g., cardioversion)
Drugs may act more slowly and less reliably than electrical treatments.
What is the initial treatment for tachyarrhythmias with adverse features?
Synchronised cardioversion
This is necessary to correct the rhythm if the patient is unstable.
What is broad-complex tachycardia characterized by?
QRS duration ≥ 0.12 s
It may be ventricular in origin or a supraventricular rhythm with aberrant conduction.
What is the treatment for regular broad-complex tachycardia presumed to be ventricular tachycardia (VT)?
Amiodarone 300 mg IV over 20–60 min
Followed by an infusion of 900 mg over 24 h.
What is Atrioventricular nodal re-entry tachycardia (AVNRT)?
The commonest type of paroxysmal supraventricular tachycardia (SVT)
It is usually benign unless there is additional structural heart disease.
What is the typical atrial rate in atrial flutter with regular AV conduction?
About 300 min-1
It may produce a regular narrow-complex tachycardia.
What type of tachycardia is AVRT?
A regular narrow-complex tachycardia, usually with no visible atrial activity on the ECG.
What is a characteristic feature of atrial flutter with 2:1 conduction?
It produces a regular narrow-complex tachycardia with an atrial rate of about 300 min-1.
What may happen if the ventricular response is slowed during atrial flutter with 2:1 conduction?
Flutter waves may become visible on the ECG.
What should be done if a patient with tachyarrhythmia has adverse features?
Perform synchronised cardioversion.
What is the first step in treating regular narrow-complex tachyarrhythmia in the absence of adverse features?
Start with vagal manoeuvres.
Which manoeuvres can terminate episodes of paroxysmal SVT?
- Carotid sinus massage
- Valsalva manoeuvre
What is the initial dose of adenosine for treating tachyarrhythmia?
6 mg as a very rapid intravenous bolus followed by a flush.
What should be done if adenosine does not terminate the tachyarrhythmia?
Give a 12 mg bolus, and if there is still no response, give another 12 mg bolus.
What condition is indicated by a pulseless and unconscious patient with tachycardia?
Pulseless electrical activity (PEA).
In the presence of irregular narrow-complex tachycardia, what is likely the arrhythmia?
Atrial fibrillation (AF) with a rapid ventricular response.
What should be initiated for a patient in AF with adverse features?
Start anticoagulation prior to cardioversion.
What is the drug of choice for rate control in AF?
Beta-blocker.
What is the definition of bradycardia?
A resting heart rate of < 60 min-1.
What should be the initial treatment for bradycardia with adverse features?
Give atropine 500 mcg IV.
