ALS management

Question 1

Signs that indicate unstable patient with arrhythmia

Answer 1

4s (not really)

Shock
Syncope
severe HF
MI

Question 2

Bradycardia - unstable

Answer 2

1. Atropine 500mcg -> up to 3mg

(alternatives - adrenaline, isoprenaline, dopamine, glucagon, aminophylline, glucopyrrolate)

2. Transcutaneous pacing
3. specialist - transvenous pacing

Question 3

Bradycardia in stable patient

Answer 3

Assess for risk of asystole

If low then observe

Question 4

Assessing risk of asystole

Answer 4

Recent asystole

Mobitz II AV block

Complete Heart block with broad QRS

Ventricular pause of >3s

Question 5

Drug used in beta blocker overdose

Answer 5

Glucagon

Also used in CCB overdose

Question 6

Drugs that can be used instead of atropine in bradycardia (unstable)

Answer 6

Glycopyrrolate

Aminophylline

Isoprenaline

Adrenaline

Glucagon

Question 7

Unstable patient with tachycardia

Answer 7

Synchronized DC shock (x3)

Amiodarone 300mg IV (10-20 mins)

Repeat DC shock

Question 8

Irregular broad complex tachycardia

Answer 8

1. AF with BBB - treat as narrow
2. Polymorphic VT - (Torsades de pointes)
   • 2g magnesium over 10 mins

Question 9

Broad complex tachycardia - regular rhythm - stable

Answer 9

If VT:
Amiodarone 300mg (over 10-60 mins)

If previous SVT with BBB:
- treat as regular narrow complex tachycardia

Question 10

Regular Narrow complex tachycardia - stable

Answer 10

1. Vagal manouvers
2. Adenosine 6mg IV bolus -> 12mg ->18mg
3. Verapamil/ betablockers
4. DC shock

Question 11

Irregular narrow complex tachycardia

Answer 11

rate control with betablocker

If HF -> give digoxin/ amiodarone

Anticoagulated if been going on for >48h

Question 12

Which drug is contraindicated in VT?

Answer 12

Verapamil