13. Emergencies- Arrthymias Flashcards
What is meant by a broad complex tachycarida?
ECG shows a rate of greater than 100 and a QRS complex greater than 0.12ms
What are some examples of broad complex tachycardias?
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
What is the initial management of broad complex tachycardias?
Pulse?
Give oxygen if sats under 90
Adverse signs?
What are adverse signs in broad complex tachycarida?
Shock (BP<90mmHg, pulse>100)
Chest pain/ischeamia
Heart failure
Syncope
What are the next steps if someone DOES NOT have adverse symptoms?
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
What are the next steps if someone DOES have adverse symptoms
Get help Sedate Up to 3 shocks Check and correct electrolytes Amiodarone 300mg (antiarrythmic) further cardioversion if needed Get some really super expert help
What should be done after the VT was corrected?
Establish the cause
Maintenance anti-arrthymic therapy
IV amiodarone, sotalol (only post MI)
surgical repair may be needed
What is torsades des pointes?
A form of Vt with constantly varying axis, often in the setting of long QT syndromes
How is torsades des pointes treated?
Congenital- high doses of b blockers
Acquired- stop predisposing drugs, correct electrolyte imbalances
What is narrow complex tachycardia?
Give some examples
HR>100, QRS<0.12
Sinus tachycarida,
Atrial tachyarrhythmias-AF,atrial flutter,atrial tachycardia
Junctional tachycardia- Av node re-entry tachycardia
How do you initially investigate narrow complex arrhtymias?
Give oxygen if under 90%
12 lead ECG
Adverse signs?
What are the adverse signs for narrow complex tachycardia?
Shock
Chest pain
Heart failure
Syncope
How do you treat if there are adverse signs?
Get expert help Sedate 3 synchronised DC shocks Check adn correct electrolytes Amiodarone 300mg
How do you treat if there aren’t adverse signs?
start continuous ECG, perform vagal manoeuvres
If they fail give adenosine bolus
If sinus rhtym not achived possibel WPW or atrial flutter
What do you do if an individual has an irregularly irregular rhythm
A fib- rate control (b blocker, ca channel blocker, digoxin) and anticogulation
What is wolff parkinson white syndrome?
Caused by congenital accessory conduction pathway between atria and ventricles
Short PR interval, Widedned QRS interval
Risk of degeneration and sudden death
What are the symptoms of bradycardia?
Fatigue, nausea, dizziness
What are the cardiac causes of bradycardia
Degenerative changes causing fibrosis Post MI Sick sinus syndorme iatrogenic Aortic valve disease
What are the non cardiac causes of bradycardia
Vasovagal
Endocrine
Metabolic
Hypothermia
What are the drug induced causes of bradycardia?
B blcokers Amiodarone Verapamil Dilitazem Digoxin
What is important to consider when managing bradycardia?
Consider the clinical state over the numbers
Call cardiologists and anesthetists as may need transcutanous pacing
How do you initially bradycardia?
Give oxygen, ECg, IV access
Identify reversible causes
Adverse signs?
What happens if patients have adverse sign sor risk of asystole?
Atropine
Transcutanous pasing
Adrenaline
seek expert help
How do you decide if someone is at risk of asystole?
Recent asystole
Mobitz type II AV block
Complete heart blcok with broad QRS
Ventricular pauses>3s
