13. Emergencies- Arrthymias Flashcards

1
Q

What is meant by a broad complex tachycarida?

A

ECG shows a rate of greater than 100 and a QRS complex greater than 0.12ms

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2
Q

What are some examples of broad complex tachycardias?

A

Ventricular tachycardia
SVT (AF or atrial flutter with bundle branch block)
Pre-excited tachycardias e.g. AF, atrial flutter or AV re-entry tachycarida with underlying WPW

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3
Q

What is the initial management of broad complex tachycardias?

A

Pulse?
Give oxygen if sats under 90
Adverse signs?

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4
Q

What are adverse signs in broad complex tachycarida?

A

Shock (BP<90mmHg, pulse>100)
Chest pain/ischeamia
Heart failure
Syncope

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5
Q

What are the next steps if someone DOES NOT have adverse symptoms?

A

Correct electrolyte problems (K,Mg,Ca)

Assess rhtyhm- regular, give amiodarone via central line. Irregular, get help

If this doesnt get better sedate and shock

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6
Q

What are the next steps if someone DOES have adverse symptoms

A
Get help
Sedate
Up to 3 shocks
Check and correct electrolytes
Amiodarone 300mg (antiarrythmic)
further cardioversion if needed
Get some really super expert help
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7
Q

What should be done after the VT was corrected?

A

Establish the cause
Maintenance anti-arrthymic therapy
IV amiodarone, sotalol (only post MI)
surgical repair may be needed

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8
Q

What is torsades des pointes?

A

A form of Vt with constantly varying axis, often in the setting of long QT syndromes

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9
Q

How is torsades des pointes treated?

A

Congenital- high doses of b blockers

Acquired- stop predisposing drugs, correct electrolyte imbalances

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10
Q

What is narrow complex tachycardia?

Give some examples

A

HR>100, QRS<0.12

Sinus tachycarida,
Atrial tachyarrhythmias-AF,atrial flutter,atrial tachycardia
Junctional tachycardia- Av node re-entry tachycardia

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11
Q

How do you initially investigate narrow complex arrhtymias?

A

Give oxygen if under 90%
12 lead ECG
Adverse signs?

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12
Q

What are the adverse signs for narrow complex tachycardia?

A

Shock
Chest pain
Heart failure
Syncope

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13
Q

How do you treat if there are adverse signs?

A
Get expert help
Sedate
3 synchronised DC shocks
Check adn correct electrolytes
Amiodarone 300mg
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14
Q

How do you treat if there aren’t adverse signs?

A

start continuous ECG, perform vagal manoeuvres

If they fail give adenosine bolus

If sinus rhtym not achived possibel WPW or atrial flutter

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15
Q

What do you do if an individual has an irregularly irregular rhythm

A

A fib- rate control (b blocker, ca channel blocker, digoxin) and anticogulation

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16
Q

What is wolff parkinson white syndrome?

A

Caused by congenital accessory conduction pathway between atria and ventricles

Short PR interval, Widedned QRS interval

Risk of degeneration and sudden death

17
Q

What are the symptoms of bradycardia?

A

Fatigue, nausea, dizziness

18
Q

What are the cardiac causes of bradycardia

A
Degenerative changes causing fibrosis
Post MI
Sick sinus syndorme
iatrogenic
Aortic valve disease
19
Q

What are the non cardiac causes of bradycardia

A

Vasovagal
Endocrine
Metabolic
Hypothermia

20
Q

What are the drug induced causes of bradycardia?

A
B blcokers
Amiodarone
Verapamil
Dilitazem
Digoxin
21
Q

What is important to consider when managing bradycardia?

A

Consider the clinical state over the numbers

Call cardiologists and anesthetists as may need transcutanous pacing

22
Q

How do you initially bradycardia?

A

Give oxygen, ECg, IV access
Identify reversible causes
Adverse signs?

23
Q

What happens if patients have adverse sign sor risk of asystole?

A

Atropine
Transcutanous pasing
Adrenaline
seek expert help

24
Q

How do you decide if someone is at risk of asystole?

A

Recent asystole
Mobitz type II AV block
Complete heart blcok with broad QRS
Ventricular pauses>3s