Advanced Life Support

Question 1

When should cardioversion be used in AF?

Answer 1

• In an emergency when the patient is haemodynamically unstable
• Electrical or pharmacological cardioversion as an elective procedure where a rhythm control strategy is preferred

Question 2

What is the treatment if the onset of AF is <48 hours?

Answer 2

Need to be put on heparin and then electrically or pharmacologically cardioverted. Then need further anticoagulation.

Question 3

What is the treatment if the onset of AF is >48 hours?

Answer 3

Need anticoagulation for 3 weeks prior to cardioversion. Then need anticoagulation for 4 weeks after.

Question 4

What is the management for supraventricular tachycardia?

Answer 4

1. Vagal manoeuvres - valsalava manoeuvre and carotid sinus massage
2. IV adenosine, rapid bolus of 6mg, then 12mg, then 18mg - verapamil preferred in asthmatics
3. Electrical cardioversion

Question 5

What is the management for ventricular tachycardia?

Answer 5

1. 1 immediate shock for VF/pulseless VT followed by CPR
2. If the collapse was witnessed then 3 successive shocks before CPR
3. IV adrenaline 1mg and amiodarone 300mg once chest compressions have started after 3 shocks
4. Repeat adrenaline 1mg every 3-5 mins, amiodarone 300mg after 5 shocks

Question 6

What is the management for non-shockable rhythms?

Answer 6

• Adrenaline IV 1mg
• CPR

Question 7

What is the management of non-collapse VT?

Answer 7

1. If haemodynamically unstable then DC cardioversion
2. If no signs present then anti-arrhythmias, if these fail then electrical cardioversion with synchronised DC shocks
3. ICD for impaired LV function