Advanced Life Support

Question 1

What adverse signs indicate potentially life threatening bradycardia?

Answer 1

Systolic BP <90

Pulse <40

Ventricuar arrhythmia

Heart failure

Question 2

What initial action should be taken for bradycardia with adverse signs?

Answer 2

Atropine 500-600 micrograms IV

Question 3

In a patient responding to atropine, what is the next step in assessing bradycardia?

Answer 3

Assess for risk of asystole, if risk is present, institute interim measures and arrange for transvenous pacing

Question 4

What factors indicate a risk for asystole in bradycardia?

Answer 4

Recent asystole

Möbitz II block

Complete heart block with ventricular escape

Ventricular pause >3 seconds

Question 5

Describe interim measures for refractory bradycardia?

Answer 5

Atropine up to 3mg

OR

Adrenaline 2-10microg/min

OR

Transcutaneous pacing

else

aminophylline, isoprenaline, glucagon (in beta-blocker or CCB toxicity)

Question 6

What initial steps should be undertaken in a deteriorating patient with tachyarrhythmia?

Answer 6

Primary survey

IV access, O₂

Monitoring

12 lead ECG

Question 7

What signs indicate an unstable patient with a tachyarrhythmia?

Answer 7

Systolic BP <90

Heart failure

End organ ischaemia (e.g., altered mental status, chest pain)

Question 8

Describe immediate management of an unstable patient with tachyarrhthmia and a pulse

Answer 8

3 x sychronised DC shock (100, 150, 200J)

THEN

amiodarone 300mg IV over 20mins

THEN

repeat shock

THEN

amiodarone 900mg IV over 24 hours

Question 9

You have identified a stable patient with a tachycardia, what is the next step in assessment?

Answer 9

Determine if the QRS duration is <0.12sec

Question 10

What management strategies are available for broad complex tachycardia with pulse?

Answer 10

Irregular QRS - seek expert help

• Possibilities include
  
  • AF w/bundle block
    
    • treat as for narrow complex
  • Pre-excited supraventricular rhythm
    
    • consider amiodarone
  • polymorphic VT
    
    • give 2g Mg over 10 mins

Regular QRS

• If VT give amiodarone 300mg over 20 mins then 900mg over 24 hours
• If known SVT w/branch block give adenosine as for normal SVT