Peri-Arrest Rhythms Flashcards Preview

Immediate Life Support and Critical illness > Peri-Arrest Rhythms > Flashcards

Flashcards in Peri-Arrest Rhythms Deck (48)
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1
Q

What are causes of bradycardia?

A
  • Sleep
  • Athletes
  • AV node block
  • Sinus nose disease
  • Vasovagal
  • Hypothermia
  • Hypothyroid
  • Hyperkalaemia
  • Beta Blockade
  • Diltiazem
  • Digoxin
  • Amiodarone
2
Q

What are adverse features of bradycardia?

A
  • Shock - SBP < 90 mmHg
  • Syncope
  • HR - < 40 BPM
  • MI
  • Heart failure
3
Q

How would you assess someone with bradycardia?

A

ABCDE

  • Monitor SPO2 +/- oxygen if hypoxic
  • Monitor ECG and BP
  • Obtain IV access
  • Identify and treat reversible cause
4
Q

If someone with bradycardia was showing adverse features, how would you treat them?

A

Atropine 500 mcg IV

5
Q

IF someone with bradycardia had no red flag features, what would you do?

A

Determine risk of asystole

  • Recent asystole
  • Mobitz II AV block
  • Complete heart block with broad QRS
  • Ventricular pause > 3s
6
Q

If there was no satisfactory response to intially treating symptomatic bradycardia with atropine, how would you proceed?

A

Consider interim measures (any of below), then seek expert help and transvenous pacing

  • Atropine 500 mcg IV repeat to max 3 mg
  • Trancutaneous pacing
  • Adrenaline 2-10 ug/mon IV
7
Q

If someone with asymptomatic bradycardia had no risk factors for asystole, how would you proceed?

A

Continue observation

8
Q

When would you consider second-line medication for treating bradycardia?

A

If bradycardia with adverse features persists despite atropine, and if pacing is unavailable

9
Q

What are the causes of AF?

A
  • Ischaemic heart disease
  • Hypertension
  • Valvular heart disease (esp. mitral stenosis / regurgitation)
  • Acute infections
  • Electrolyte disturbance (hypokalaemia, hypomagnesaemia)
  • Thyrotoxicosis
  • Drugs (e.g. sympathomimetics)
  • Pulmonary embolus
  • Pericardial disease
  • Acid-base disturbance
  • Pre-excitation syndromes
  • Cardiomyopathies: dilated, hypertrophic.
  • Phaeochromocytoma
10
Q

What are high risk features of AF?

A
  • HR > 150
  • Ongoing chest Pain
  • Critical perfusion/haemodynamic instability - shock, syncope, MI, heart failure
11
Q

If someone was displaying high risk features of AF, what would you do?

A

Seek expert help

  • Immediate heparin and synchronised DC cardioversion
12
Q

What defibrillation setting should you begin on for synchronised DC cardioversion?

A

120-150J biphasic. Increase in increments if this fails

13
Q

If intial DC cardioversion fails to treat AF with adverse features, what else can be done?

A
  • Amiodarone 300 mg IV over 60 minutes, followed by IV infusion 900mg over 24 hours
  • Repeat shock
14
Q

What are immediate risk features of AF?

A
  • Rate 100-150
  • Breathlessness
  • Poor perfusion
15
Q

If someone had immediate risk features of AF, what would you want to establish?

A

Are there features of haemodynamic compromise +/- known structural heart disease

16
Q

When are patients with unstable AF most at risk of develop embolic complications?

A

>48 hours after onset

17
Q

If someone was not displaying haemodynamic disruption or adverse features of AF, but was symptomatic with AF, what would you want to know?

A

How long it had been since onset? (>48hours?)

18
Q

If someone with AF was not displaying features of haemodynamic instability, and it had been <48 hours, how would you manage them?

A
  • Give oxygen if needed
  • Assess for heart failure
  • Consider ECHO - look for TE
  • Treat based on “48 hr window” and presence of TE
  • Determine thromboembolism and bleeding risks
19
Q

How would you attempt to chemically cardiovert someone with AF?

A

Flecanide 100-150 mg IV over 30 minutes

or

Amiodarone 300 mg over 1 hr

20
Q

If someone with AF was haemodynamically stable but had been experiencing AF for >48 hours, how would you manage them?

A

Initial rate control

  • B-blockers
  • Verapimil/Diltiazem
  • Digoxin

TOE + Consider Anticoagulation

  • DOAC
  • Heparin, followed by Warfarin

DC CArdioversion after 3 weeks anticoagulation

21
Q

If someone had narrow complex tachycardia, was pulseless and had a rate >250 BPM, how would you manage them?

A

Synchronised DC cardioversion

22
Q

If someone had a narrow complex tachycardia that was regular and showing no adverse features, how would you manage them?

A
  • Give oxygen and monitor SpO2
  • Obtain IV access
  • ECG monitoring + BP
  • Vagal manouvres
  • Adenosine 6 mg rapid bolus - followed by 12 mg every 2-3 mins if unsuccsessful
23
Q

If someone with narrow complex tachycardia was given adenosine, and sinus rhythm was not restored, what would you do?

A

Seek expert help

24
Q

How would you initially manage a broad complex tachycardia?

A
  • IV access
  • Oxygen
  • Assess for pulse
25
Q

If there was no pulse with a broad complex tachycardia, how would you manage the situation?

A

As per VF protocol

26
Q

If someone had broad complex tachycardia with a pulse, what would you want to do?

A

Assess for adverse signs

  • SBP < 90 mmHg
  • Chest Pain
  • Heart failure
  • HR > 150 bpm
27
Q

If someone had broad complex tachycardia with no adverse signs, how would you manage them?

A

Assess potassium - intervene if low

Medication administration

  • Amiodarone 300 mg IV over 10mins
  • Lidocaine IV 50 mg over 2 minutes, every 5 minutes up to 200 mg
28
Q

If someone with broad complex tachycardia with a pulse was showing signs of haemodynamic instability, how would you manage them?

A

Seek expert advise

  • Synchronised DC cardioversion
  • Treat potassium if low
  • Amiodarone 150 mg IV over 10 mins
29
Q

If someone with broad complex tachycardia with a pulse had low potassium, what would you do?

A
  • Give KCl up to 60 mmol
  • Give Magnesium sulphate IV 5ml 50% in 30 minutes
30
Q

Under what conditions is DC cardioversion performed in a peri-arrest situation?

A

Sedated or under GA

31
Q

What is the generic approach you should take to assessing and intervening with peri-arrest arrythmias?

A
  1. Assess a patient using ABCDE
  2. Note presence or absence of ‘adverse features’
  3. Give oxygen immediately to hypoxaemic patients - adjust as per SpO2
  4. IV cannula
  5. ECG - will help identify the precise rhythm
  6. Correct any electrolyte abnormalities (e.g. K+, Mg2+, Ca2+).
32
Q

What is a regular broad complex tachycardia likely to be?

A
  • VT
  • Regular SVT with BBB
33
Q

How would you approach managing SVT with BBB?

A

Similarly to treating regular, narrow complex tachycardia

34
Q

What is the most likely cause of Irregular broad complex tachycardia?

A

AF with BBB

35
Q

What are causes of irregular broad complex tachycardias?

A
  • AF with BBB
  • AF with ventricular pre-excitation (WPW patients)
  • Torsades de pointes
36
Q

How would you manage torsades de pointes VT?

A
  • Stop all QT prolonging drugs
  • Correct electrolyte abnormalities
  • Give magnesium sulphate 2g over 10 minutes
37
Q

What would you not give in torsades de pointes?

A

Amiodarone

38
Q

How would you manage someone with adverse features of torsades de pointes?

A

Synchronised cardioversion

39
Q

How would you manage someone with torsades de pointes who became pulseless?

A

Attempt defibrillation immediately

40
Q

What are the types of regular narrow complex tachycardias that can occur?

A
  • Sinus tachycardia
  • AVNRT
  • AVRT
  • Atrial flutter with regular AV conduction
41
Q

What regular narrow complex tacycardias are usually benign?

A
  • AVNRT
  • AVRT
42
Q

When can AVNRT not be benign?

A

If there are additional structural heart problems/coronary disease

43
Q

When would you not give adenosine when treating regular, narrow complex tachycardia?

A

If it is atrial flutter

44
Q

How quickly should adenosine or vagal manouvres terminate AVNRT or AVRT?

A

Within seconds

45
Q

What would failure to terminate regular, narrow complex tachycardia using either vagal manouvre or adenosine suggest as the cause?

A

Atrial flutter - unless adenosine injected too slowly/into peripheral vein

46
Q

When might you consider chemical cardioversion when treating AF?

A

If duration < 48hrs and rhythm control is deemed appropriate

47
Q

When would you not use flecanide when chemically cardioverting someone in AF?

A
  • Heart failure
  • Left ventricular impairment
  • IHD
  • Prolonged QT interval
48
Q

What patient group should you not give atropine to to trreat bradycardia?

A

Cardiac transplant patients