Acute Arrhythmias General

Question 1

ACLS Algorithm for Algorithm for Pulseless VT or VF

Answer 1

Defibrillation, CPR 2 mins (up to 2 times) then epinephrine 1 mg IV/IO q3-5 min, defibrillation, amiodarone 300 mg IV/IO × 1; may repeat at 150-mg bolus × 1; lidocaine may also be considered

Question 2

ACLS Algorithm for Asystole or PEA

Answer 2

CPR 2 mins then epinephrine 1 mg IV/IO q3-5 min

Question 3

If no IV/IO access in ACLS

Answer 3

endotracheal administration of epinephrine, lidocaine, and atropine is allowed at 2–2.5 times the recommended IV/IO dose.
Dilute this dose with 5–10 mL of sterile water or normal saline

Question 4

Targeted Temperature Management indication and goal

Answer 4

Indicated in adult patients who are comatose in whom return of spontaneous circulation (ROSC) has been achieved after cardiac arrest
Goal temperature: 32°C–36°C for At least 24 hours after achieving the goal temperature

Question 5

Agents for shivering during TTM

Answer 5

meperidine, buspirone, clonidine, dexmedetomidine, and neuromuscular blocking agents.

Question 6

Symptomatic Bradycardia 1st Line Agent

Answer 6

If unstable, atropine 1 mg every 3–5 minutes (maximum dose 3 mg). (Note: Unstable = hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute HF)

Question 7

Symptomatic Bradycardia 2nd Line Agents

Answer 7

If atropine fails, transcutaneous pacing, dopamine 5–20 mcg/kg/minute, or epinephrine 2–10 mcg/minute

Question 8

Types of Stable Symptomatic Tachycardia

Answer 8

Narrow complex Regular ventricular rhythm: Supraventricular tachycardia (SVT) or sinus tachycardia likely
Irregular (narrow complex) ventricular rhythm: AF (or possibly atrial flutter)
Wide-complex tachycardia (QRS greater than 120 milliseconds): Usually ventricular arrhythmias

Question 9

Narrow-complex Regular ventricular rhythm therapy

Answer 9

Vagal maneuvers or adenosine 6-mg intravenous push, followed by a 20-mL saline flush,
then a 12-mg intravenous push (may repeat once)
Rapid push followed by elevation of arm to increase circulation

Question 10

Adenosine for Tachycardia Dose Adjustments

Answer 10

Larger doses may be needed in patients taking theophylline or caffeine.
Initial dose should be reduced to 3 mg in patients taking dipyridamole or carbamazepine and in patients after heart transplantation, and when the drug is being given by central access.

Question 11

Adenosine for Tachycardia Cautions

Answer 11

Use adenosine cautiously in severe CAD.
should not be given to patients with asthma.
do Not give for unstable or for irregular or polymorphic wide-complex tachycardias because it can cause degeneration to ventricular fibrillation (VF).

Question 12

Irregular (narrow complex) ventricular rhythm initial therapy

Answer 12

General management should focus on control of the rapid ventricular rate.
Usually non-dihydropyridine CCBs (diltiazem, verapamil) or β-blockers; digoxin sometimes useful

Question 13

Atrial fibrillation up to 7 days therapy

Answer 13

either elective direct current conversion or chemical cardioversion Flecainide, dofetilide, propafenone, ibutilide, or amiodarone (proven efficacy)

Question 14

Atrial fibrillation greater than 7 days therapy

Answer 14

administer either elective direct current conversion or chemical cardioversion with dofetilide, amiodarone, or ibutilide (proven efficacy)

Question 15

Wide-complex tachycardia therapy

Answer 15

Consider adenosine only if regular and monomorphic.
Intravenous procainamide, amiodarone (or sotalol); lidocaine second line